Hypertensive microangiopathic angina with left ventricular hypertrophy: treatment with enalapril

Abstract

This paper addresses the diagnostic issues involved in exertional angina with normal coronary arteriograms in hypertension and describes the results of treatment with the ACE inhibitor enalapril. From the diagnostic point of view, identification of the syndrome is based on the following: chronic arterial hypertension, exertional angina, left ventricular hypertrophy, a normal coronary arteriogram, stress gamma scintigraphy with an abnormal thallium 201 uptake and reduced coronary flow reserve. Of 120 consecutive hypertensive patients, 11 met these conditions (62% of all angina patients). The 11 patients meeting the criteria were treated with 20–40 mg enalapril per day until blood pressure was normalized. The results were as follows: disappearance of angina in nine, regression of hypertension and of left ventricular hypertrophy in all 11, normalized thallium 201 uptake in 10 of the 11, and improved coronary flow reserve in all. We conclude that microvascular angina is frequent in hypertensive patients (62% of all cases of anginas) and that treatment with enalapril is consistent with elimination of angina, reduced left ventricular hypertrophy and normalized thallium 201 uptake.