Artery Disease In Hypertensive Patients Research Articles

4.12: A comparative study of dobutamine stress myocardial perfusion imaging and dobutamine stress echocardiography in the detection of coronary artery disease in hypertensive patients

4.12: A comparative study of dobutamine stress myocardial perfusion imaging and dobutamine stress echocardiography in the detection of coronary artery disease in hypertensive patients

The Diagnostic Value of Adenosine Stress-Contrast Echocardiography for Diagnosis of Coronary Artery Disease in Hypertensive Patients: Comparison to Tl-201 Single-Photon Emission Computed Tomography

The use of the vasodilating agent adenosine as stressor in conjunction with myocardial contrast echocardiography has not been extensively evaluated in hypertensive patients. Our aim was to evaluate the diagnostic value of adenosine myocardial contrast echocardiography (MCE) in comparison to single-photon emission computed tomography (SPECT), with reference to angiographic findings, in a hypertensive population. Fifty hypertensive subjects, treated with standard antihypertensive treatment, were submitted to adenosine stress MCE, adenosine SPECT, and coronary angiography within a 1-month period, without any intervening events. Sensitivity, specificity, and accuracy were 88%, 89%, 88% for MCE and 80%, 94%, 85% for SPECT, respectively (P = not significant). In the analysis by coronary territory, it appears that MCE and SPECT are both more accurate in detecting lesions of the anterior than of the posterior coronary system, as suggested by the good concordance to angiography results in the left anterior descending artery territory (k = 0.640 and 0.671, respectively). Agreement with angiographic findings was moderate for the right coronary artery (k = 0.561 and 0.539, respectively), whereas left circumflex artery lesions were more accurately detected by MCE than by SPECT (k = 0.533 and 0.400, respectively), that is, MCE appears to be superior in the left circumflex artery territory. In hypertensive patients, adenosine MCE has similar overall diagnostic accuracy with SPECT for assessment of coronary artery disease but is superior in the left circumflex artery territory.

Reverse Pulse Pressure Amplification Predicts Coronary Artery Disease in Hypertensive Patients

Reverse Pulse Pressure Amplification Predicts Coronary Artery Disease in Hypertensive Patients

We-P11:188 Reduced aortic root compliance status and likelihood of associated coronary artery disease in hypertensive patients

This present study evaluated the subgingival microbiota of the Cebus apella with different periodontal conditions kept by the Tufted Capuchin Monkey Procreation Center (São PauloState University – UNESP) or free-ranging monkeys. For this purpose, clinical specimens of subgingival biofilm were collected from 52 monkeys, of both genders, 40 kept in captivity and 12 free-ranging monkeys. The primates were submitted to periodontal evaluation and biofilm samples were transferred to VMGA III transport medium and ultrapure water. The microbiota was cultivated in selective and non-selective culture media and microbial DNA was extracted and the presence of periodontal pathogens was evaluated using PCR and real-time PCR. The actinomycetes, fusobacteria, Campylobacter rectus, Eikenella corrodens, black-pigmented Gram-negative anaerobic rods, Tannerella forsythia, staphylococci and streptococci represent the predominantly detected microorganisms. Aggregatibacter actinomycetemcomitans, Dialister pneumosintes and Prevotella nigrescens were rarely observed, whereas Treponema denticola was not found. Populations of C. rectus, E. corrodens, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, T. forsythia and the total microbial load were significantly higher in animals with bone loss and, in smaller extension, in animals with gingival bleeding.

736 Comparison of myocardial contrast echo with single photon emission computed tomography for detection of coronary artery disease in hypertensive patients with chest pain

736 Comparison of myocardial contrast echo with single photon emission computed tomography for detection of coronary artery disease in hypertensive patients with chest pain

Thoughts evoked by MATCH and other trials.

Many different processes are involved in platelet activation. Most drugs affect one of these chemical reactions. Theoretically, platelet functions (secretion, aggregation, and adhesion) can be reduced most effectively by using >1 agent or by inhibiting the final step in the attachment of the platelet to fibrin at the level of the glycoprotein IIb/IIIa (GpIIb/IIIa) receptor. Preliminary experience with oral and intravenous GpIIb/IIIa inhibitors has shown that bleeding is an important problem. In MATCH, 2 platelet function inhibitors, clopidogrel and aspirin, did prevent slightly more strokes (but not with statistical significance) but at the price of significantly more excess bleeding. Killing platelets causes bleeding. Platelets seem to swim happily in the blood until they reach an area of irregular or damaged endothelium, for example, on the surface of an ulcerated atherosclerotic plaque in a large artery. They then stick to that irregular surface and to each other in an attempt to heal the vascular irregularity. The white platelet–fibrin thrombus can break loose and embolize. The platelet plug also activates the coagulation cascade, promoting the formation of a red erythrocyte–fibrin-rich clot. Perhaps rather than killing the platelet, it might be better to inhibit platelet attachment to the endothelium. Antiplatelet drugs might do this but have not been tested thoroughly for their effect on endothelial–platelet interaction. Theoretically, antiplatelet agents should work by inhibiting formation of white clots. These tend to form on irregular …

ASCOT-LLA and the primary prevention of coronary artery disease in hypertensive patients.

Although each revision of the US National Cholesterol Education Program guidelines has made increasing provision for the use of global risk assessment in determining need for and intensity of therapy, the guidelines' continued focus on low-density lipoprotein (LDL) cholesterol may result in inadequate or no treatment for individuals at high risk for coronary artery disease (CAD) who do not have substantially elevated LDL cholesterol. However, recent clinical trial evidence has shown that high-risk patients benefit from lipid-regulating therapy regardless of LDL cholesterol level. In the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm, high-risk hypertensive patients had reductions in clinical events despite not having substantially elevated LDL cholesterol at baseline. These results suggest that all hypertensive patients with additional risk factors should receive lipid-regulating statin therapy to prevent CAD events.

Ventricular diastolic function doppler parameters as markers of coronary artery disease in hypertensive patients

Ventricular diastolic function doppler parameters as markers of coronary artery disease in hypertensive patients

Advantages of exercise echocardiography in comparison to dobutamine echocardiography in the diagnosis of coronary artery disease in hypertensive subjects

The aim of the study was to compare the efficacy and safety of two stress echocardiography methods, exercise and dobutamine, in the diagnosis of coronary artery disease in hypertensive patients with angina. A total of 197 treated hypertensive patients, age 53 +/- 9 years (65 women) with no history of myocardial infarction referred for coronary angiography were prospectively investigated with exercise electrocardiography (ECG), exercise and dobutamine echocardiography. Sensitivity of the exercise ECG, exercise echocardiography and dobutamine echocardiography did not differ (77%, 82% and 75%). Negative predictive value of exercise ECG was significantly lower than exercise echocardiography (64% vs 79%, P < 0.01). Specificity and positive predictive value of exercise ECG were markedly lower than exercise and dobutamine echocardiography (57%, 96%, 98% and 72%, 97%, 98%, P < 0.0001 for both stress echocardiography vs ECG). Specificity and sensitivity of diagnostic methods were not influenced by the presence of echocardiographic left ventricular hypertrophy. Dobutamine infusion in comparison to exercise was more often associated with substantial arterial blood pressure rise or fall (7% vs 2%, P < 0.05) and with simple ventricular ectopy (15,7% vs 6,1%, P < 0.05). In hypertensive patients with the symptoms of angina, both stress echo methods are significantly more specific than the exercise ECG test. Maximal exercise is associated with less frequent side effects than infusion of dobutamine, so exercise echocardiography may be preferred in the diagnosis of angina in hypertensive patients.

Coronary artery disease in hypertensive patients with heart failure and left bundle branch block: diagnostic utility of adenosine TC99 tetrofosmin SPECT

Coronary artery disease in hypertensive patients with heart failure and left bundle branch block: diagnostic utility of adenosine TC99 tetrofosmin SPECT

Relation between left ventricular mass index (LVMI) and coronary artery disease in hypertensive patients with left ventricular hypertrophy (LVH), role of thallium SPECT

Relation between left ventricular mass index (LVMI) and coronary artery disease in hypertensive patients with left ventricular hypertrophy (LVH), role of thallium SPECT

Hypertension: Where have we gone wrong and how can we fix it?

Hypertension is defined as a disease of elevated systolic and diastolic blood pressure and consequently the goals of treating hypertension have been simply to normalize the blood pressure. However, effective blood pressure control has not resulted in the expected decreases in coronary artery disease. These findings have forced researchers to reexamine the importance of blood pressure in causing coronary artery disease, and to pose the question “Is there more to hypertension than high blood pressure?” Although there are probably several reasons for the poor reduction in the incidence of coronary artery disease in hypertensive patients, one of the most compelling appears to be the realization that hypertension is not simply a disease of numbers, but is a complex inherited syndrome of cardiovascular risk factors, all of which contribute to heart disease in these patients. Included in the hypertension syndrome are abnormalities of lipid profile, insulin resistance, changes in renal function, endocrine changes, obesity, abnormalities of coagulation factors, left ventricular hypertrophy and diastolic dysfunction, and abnormalities of vascular structure and compliance. In many patients, high blood pressure is a late manifestation of this disease process and is preceded by some or all of the associated cardiovascular risk factors. Perhaps where we have gone wrong in the management of hypertension is in the belief that this is simply a disease of numbers. To improve our management, we need to find methods to diagnose these patients early in the course of this disease process, and to treat it as a syndrome rather than as a number.

Systemic hypertension and coronary artery disease: the link

A direct, continuous, and independent association between blood pressure values and incidence of coronary artery disease has been well documented. However, the evidence that the reduction of blood pressure alone is not able to completely reverse the increase in the risk of coronary artery disease associated with essential hypertension suggests that the link between hypertension and coronary artery disease is a complex process including other factors beside the increase in blood pressure values. In this regard, the main determinant of coronary artery disease in hypertensive patients seems to be the development of left ventricular hypertrophy (LVH). In fact, hypertensive patients who died from sudden cardiac death showed a lesser degree of coronary atherosclerosis compared with normotensives, but a higher incidence of LVH. Several mechanisms can account for the increased coronary risk with LVH, including (1) an increase in left ventricular (LV) mass, which by itself requires more oxygen for tissue perfusion; (2) impairment of coronary flow reserve; (3) perivascular fibrosis, which then impairs oxygen supply to the myocardium; and (4) deterioration of LV diastolic function, which hampers myocardial perfusion. Recently, a study reported an impairment of endothelial function and abnormal control of the sympathetic tone in hypertensive patients, which may contribute to the risk of coronary artery disease. In particular, the impaired endothelial function resulting in a prevalence of vasoconstrictive, thrombogenic, and proliferative factors may account for the enhanced ischemic susceptibility of these patients. Furthermore, the cardiac adrenergic system plays an important role in regulating myocardial blood flow. On one hand, hypertensive patients show an exaggerated sympathetic response to physiologic stimuli, whereas on the other hand, the β-adrenergic receptor-mediated vasodilating component of the sympathetic response is blunted in hypertension. Finally, excess body weight, dyslipidemia, glucose intolerance, and hyperinsulinemia, which are frequently interrelated, represent independent predictors of both coronary artery disease and hypertension.

Dobutamine Stress Echocardiooraphy for Detection of Coronary Artery Disease in Hypertensive Patients

Dobutamine Stress Echocardiooraphy for Detection of Coronary Artery Disease in Hypertensive Patients

Comparison of dobutamine stress echocardiography and MIBI SPECT imaging for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy

Comparison of dobutamine stress echocardiography and MIBI SPECT imaging for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy

Calcium Channel Blockers

Calcium channel blocking drugs have held great promise for the treatment of a variety of cardiovascular diseases, including angina pectoris, systemic and pulmonary hypertension, certain cardiac arrhythmias, and Raynaud's disease. Their popularity has increased considerably over the past decade and at present, calcium channel blockers are prescribed as frequently for hypertension as are diuretics and angiotensinconverting enzyme (ACE) inhibitors and more than β-blockers.¹However, although calcium channel blockers represent an important part of the therapeutic armamentarium against cardiovascular diseases, concerns have been raised about these drugs, particularly the short-acting dihydropyridine derivatives. The results of the Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS) reported in this issue of The Journal²add to these concerns. See also p 785. MIDAS was a large, randomized, double-blind, and expensive clinical trial that compared the effects of isradipine, a short-acting dihydropyridine, and hydrochlorothiazide on the course of carotid artery disease in hypertensive patients. The

I18 - Role of smoking in angiographically proven coronary artery disease in hypertensive patients

I18 - Role of smoking in angiographically proven coronary artery disease in hypertensive patients

986-78 Improved Detection of Coronary Artery Disease in Hypertensive Patients by Dobutamine Stress Echocardiography

From a cohort of 43 hypertensive patients (BP &gt; 160/95 mmHg) who had undergone coronary angiography for the diagnosis of chest pain, the results of exercise testing (EXT) and dobutamine stress echocardiography (Echo) were compared to assess their relative roles for the detection of coronary artery disease. These selected patients had no electrocardiographic evidence of left ventricular hypertrophy or basal ST-T changes. Graded stress dobutamine (5–40 μ g/kg/min) Echo was carried out until end-points were achieved. Graded treadmill EXT was performed using the Bruce protocol. A coronary artery lesion &gt;50% was considered significant. Left ventricular mass index was calculated by Echo and 28 out of the 43 patients had increased left ventricular mass index. Coronary artery disease was present in 29, of whom, 21 had multi-vessel disease, and 14 patients had normal coronary anatomy. Sensitivity and specificity for the detection of coronary artery disease by dobutamine Echo were 93% and 100%, and for the EXT these were 72% and 29%, respectively. Similarly, for detection of multi-vessel disease the values were 82% and 95%, for dobutamine Echo and 77% and 33% for EXT, respectively. Logistic regression analysis revealed that EXT was a poor predictor of coronary artery disease (p = 0.09) while dobutamine Echo was significantly better (p &lt; 0.001). When patients with increased left ventricular mass index were excluded, prediction of coronary anatomy by EXT improved only marginally (p = 0.4) while dobutamine Echo remained unchanged (p &lt; 0.001). Stress dobutamine Echo is safe in hypertensive patients and is probably the method of choice for evaluating underlying coronary artery disease.

Binswanger Disease: The King Khalid University Hospital Experience

Two hundred and twenty-one Saudi patients admitted for stroke in King Khalid University Hospital between 1982 and 1987 were evaluated clinically and by laboratory and radiological investigations. Twelve patients were found to have leukoraiosis on brain CT and a clinical picture compatible with Binswanger disease (subcortical arteriosclerotic encephalopathy). Arterial hypertension was present in all cases, seizure disorders in 25%, and dementia in 83%. The features of these cases are compared with similar cases reported from other places. The importance of control of hypertension in prevention of Binswanger disease is emphasized.

Comparative trial of doxazosin and atenolol on cardiovascular risk reduction in systemic hypertension

The impact of treating hypertension on coronary artery disease has been less than anticipated from epidemiologic studies of cardiovascular risk factors. It has been suggested that adverse effects on lipids of traditional diuretic or β-blocker regimens may diminish the potential benefits of antihypertensive therapy. Patients with mild to moderate systemic hypertension and normal serum lipids (n = 191) were randomly assigned to doxazosin or atenolol. After dose titration to goal diastolic blood pressure of ≤ 90 mm Hg, patients continued treatment for a further 24 weeks. The principal outcome measurement was overall coronary artery disease risk using the Framingham formula. Relative risk of coronary artery disease was reduced to 92.4% of baseline (p = 0.144) for evaluable patients taking atenolol (n = 71), and to 74.6% (p = 0.0001) for patients taking doxazosin (n = 51): atenolol versus doxazosin, p = 0.0074. In patients who met the strict Framingham criteria for age, total cholesterol and high density lipoprotein cholesterol, the relative risk of coronary artery disease for patients taking atenolol (n = 23) was reduced to 86.2% of baseline (p = 0.082), and to 67.4% (p = 0.0004) for patients taking doxazosin (n = 18): atenolol versus doxazosin, p = 0.049. Alpha blockade with doxazosin was more effective than β blockade with atenolol in reducing the risk of coronary artery disease in hypertensive patients because of the beneficial effects of doxazosin on highdensity lipoprotein cholesterol. Overall withdrawal rate was greater in the α-blocker group because of a lower response rate and more adverse events.