[Exercise hemodynamic in hypertension associated with coronary microangiopathy, coronary heart disease and without ischemic syndrome effect of nifedipine].

OBJECTIVE

Is heart function during exercise impaired in hypertensive patients with effort angina and ST-segment depression but normal coronary angiograms?

METHODS AND RESULTS

In 12 hypertensive patients (group 1; aged 53 +/- 4 yrs), who had ST-segment depression during exercise, concomitant angina pectoris but normal coronary angiograms, and no LVH, left ventricular function at rest and during exercise was studied by cardiac catheterization and compared with 12 hypertensives with CAD (group 2; aged 56 +/- 5 yrs) and 12 hypertensives without ST-segment depression (group 3; aged 56 +/- 7 yrs) after discontinuation of all cardiac medications. PCWP was normal at rest and pathologically increased at 79.2 +/- 17.9 watts only in group 1 and 2 (30.2 +/- 6 mm Hg; 31.5 +/- 5 mm Hg, respectively) but not in group 3 (18.5 +/- 3 mm Hg; p < 0.001). Repeated measurements during exercise and 30 min after 10 mg nifedipine orally, showed a significant (p < 0.001) and nearly identical fall in MAP, an increase in CI (p < 0.01), and an unchanged HR x SBP in all groups. However there were significant differences in decrease of PCWP (group 1: -41.4%; group 2: -22.9%, p < 0.01; group 3: -25.4%, p < 0.01) with concomitant reduction in ST-segment depression (p < 0.01) in group 1 and 2 (-43.7% and -36% respectively).

CONCLUSIONS

ST-segment depression during exercise ECG with concomitant angina pectoris is not a false-positive finding in hypertensive patients with normal angiograms and without LVH but demonstrates myocardial ischemia, resulting in an impaired left ventricular heart function. This seems to be mainly caused by a functional changeable disorder of the coronary vascular bed as heart function is improved after nifedipine.