Un S, Mengden T, Glänzer K, Vetter H
Medizinische Universitäts-Poliklinik, Bonn.
Praxis (Bern 1994). 2000 Apr 27;89(18):757-64.
Silent myocardial ischemia occurs in hypertensive individuals with a prevalence of approximately 35%. ST-alterations are triggered by a) hypertensive peaks and b) heart rate increase. Like in patients with coronary heart disease most ischemic events occur without angina. They are clinically silent. In daily practice silent myocardial ischemia may be detected by ECG under physical load or with 24 h Holter ECG-monitoring. The latter can detect ischemic events missed by ECG-monitored exercise tolerance. In hypertensive patients the simultaneous, ST-triggered recording of ECG and blood pressure data is more meaningful. Patients with silent ischemia are at higher risk than individuals without. Angor is not as strong a determinant of risk as silent ischemia. Hypertensive patients without coronary artery disease (CAD) who have silent ischemia may even have a worse prognosis than those with known CAD. It is therefore important to substantiate the objective extent of silent ischemia by ST-analysis. If detected it has to be included into therapeutic considerations with the goal to prevent such episodes by antihypertensive treatment.
无症状性心肌缺血发生在高血压患者中，患病率约为35%。ST段改变由以下因素触发：a）高血压峰值；b）心率增加。与冠心病患者一样，大多数缺血事件发生时无胸痛症状。这些事件在临床上是无症状的。在日常实践中，无症状性心肌缺血可通过运动负荷下的心电图或24小时动态心电图监测检测到。后者可以检测到心电图监测运动耐量时遗漏的缺血事件。在高血压患者中，同时进行ST段触发的心电图和血压数据记录更有意义。无症状性缺血患者比无缺血者风险更高。胸痛并非像无症状性缺血那样是一个强烈的风险决定因素。无冠状动脉疾病（CAD）但有无症状性缺血的高血压患者，其预后甚至可能比已知患有CAD的患者更差。因此，通过ST段分析证实无症状性缺血的客观程度很重要。如果检测到无症状性缺血，必须将其纳入治疗考虑，目标是通过抗高血压治疗预防此类发作。
