Elhendy A, van Domburg R T, Bax J J, Ibrahim M M, Roelandt J R
Thoraxcenter, University Hospital Rotterdam-Dijkzigt, Rotterdam, The Netherlands.
J Hypertens. 1999 Nov;17(11):1601-6. doi: 10.1097/00004872-199917110-00014.
Myocardial perfusion abnormalities may occur in hypertensive patients in absence of significant coronary artery disease. However, it is not well established whether hypertensive patients without known coronary artery disease have a higher prevalence or extent of myocardial perfusion abnormalities compared with normotensive patients with similar clinical features.
This study compares the prevalence and extent of rest and stress-induced myocardial perfusion abnormalities in patients with and without hypertension.
Dobutamine (up to 40 microg/kg per min) stress technetium-99m myocardial perfusion SPECT imaging was performed for evaluation of myocardial ischaemia in 350 patients (mean age = 60+/-13 years, 146 men) without known coronary artery disease. One hundred and forty-eight patients were hypertensive. Rest SPECT images were acquired 24 h after the test Abnormal perfusion was defined as the presence of reversible or fixed perfusion defects.
No significant difference was detected between patients with and without hypertension regarding gender, prevalence of symptoms, risk factors, pretest probability of coronary artery disease (52+/-28 versus 53+/-29%), peak rate pressure product (21040+/-4755 versus 20774+/-4865) or number of patients achieving the target heart rate during stress (85 versus 86%). Hypertensive patients were significantly older (62+/-11 versus 58+/-13 years, P = 0.005) and were receiving beta-blockers more frequently (34 versus 18%, P = 0.0001). The prevalence of myocardial perfusion abnormalities was similar in patients with and without hypertension (28 versus 31% in patients with low, 38 versus 33% in patients with intermediate and 60 versus 58% in patients with high pretest probability of coronary artery disease, respectively). No significant difference was detected between the two groups regarding stress perfusion defect score (1.45+/-2.5 versus 1.50+/-2.6) or rest score (0.72+/-1.8 versus 0.68+/-1.6).
Treated hypertensive patients without known coronary artery disease have a similar prevalence and severity of myocardial perfusion abnormalities at rest and at dobutamine stress compared with normotensive patients with similar clinical characteristics.
高血压患者在无明显冠状动脉疾病时可能出现心肌灌注异常。然而，与具有相似临床特征的血压正常患者相比，无已知冠状动脉疾病的高血压患者心肌灌注异常的患病率或程度是否更高，目前尚无定论。
本研究比较了有高血压和无高血压患者静息及多巴酚丁胺负荷诱导的心肌灌注异常的患病率和程度。
对350例无已知冠状动脉疾病的患者（平均年龄=60±13岁，男性146例）进行多巴酚丁胺（最大剂量40μg/kg每分钟）负荷99m锝心肌灌注单光子发射计算机断层扫描成像，以评估心肌缺血情况。其中148例患者为高血压患者。负荷试验后24小时采集静息单光子发射计算机断层扫描图像。异常灌注定义为存在可逆或固定灌注缺损。
有高血压和无高血压患者在性别、症状患病率、危险因素、冠状动脉疾病的试验前概率（52±28%对53±29%）、峰值心率血压乘积（21040±4755对20774±4865）或负荷时达到目标心率的患者数量（85%对86%）方面未检测到显著差异。高血压患者年龄显著更大（62±11岁对58±13岁，P=0.005），且更频繁地接受β受体阻滞剂治疗（34%对18%，P=0.0001）。有高血压和无高血压患者心肌灌注异常的患病率相似（冠状动脉疾病试验前概率低的患者中分别为28%对31%，中等的患者中为38%对33%，高的患者中为60%对58%）。两组在负荷灌注缺损评分（1.45±2.5对1.50±2.6）或静息评分（0.72±1.8对0.68±1.6）方面未检测到显著差异。
与具有相似临床特征的血压正常患者相比，经治疗的无已知冠状动脉疾病的高血压患者在静息和多巴酚丁胺负荷时心肌灌注异常的患病率和严重程度相似。
