How can we diagnose coronary heart disease in hypertensive patients?

Abstract

Chest pain is a common complaint among hypertensive patients. Hypertension and coronary heart disease each may present with symptoms and signs that are clinically indistinguishable. Noninvasive testing by routine exercise stress testing and stress radionuclide angiography are not reliably predictive of ischemia resulting from obstructive epicardial coronary artery disease and should be abandoned for that diagnostic purpose. Noninvasive thallium-201 myocardial perfusion imaging for this purpose may prove to be a valuable tool, avoiding the risk and expense of coronary arteriography. However, carefully performed prospective studies are not available. Because of the high prevalence of both diseases, a high priority must be given to obtaining these data and evaluating other noninvasive methods (especially positron emission tomography) if they appear promising.

The Contribution of Hypertension to Black-White Differences in Likelihood of Coronary Artery Disease Detected During Elective Angiography

“…10,12 Hypertensive disease can certainly mimic CAD on clinical presentation: microvascular disease has been postulated to cause chest pain, 16,17 and left ventricular hypertrophy can be responsible for a symptomatic presentation including chest pain and electrocardiogram changes. 7,15 Hypertension can also lead to false positive results on initial diagnostic evaluation; the specificity of many noninvasive tests for CAD have been shown to be 24,25 Moreover, patients with hypertensive heart disease, including left ventricular hypertrophy and eventual heart failure, may appear to be sicker and at higher risk of cardiac death, prompting clinicians to undertake catheterization. We feel it is important to examine the potential causes of black-white differences in rates of CAD found during angiography.…”

Selecting the Best Noninvasive Imaging Test to Guide Treatment After an Inconclusive Exercise Test

“…Hypertensive patients Accurate diagnosis of obstructive epicardial CAD in hypertensive patients is important because the prevalence of disease is higher in this group than in normotensive populations [23][24][25]. However, detection of CAD in hypertensive patients may be challenging in the presence of electrocardiographic evidence of left ventricular hypertrophy (LVH) [26].…”

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

“…The diagnosis of coronary artery disease in hypertensive subjects is frequently difficult because of the various processes that contribute to myocardial ischaemia like coronary microangiopathy and left ventricular hypertrophy. 1 Noninvasive diagnosis of atherosclerotic coronary artery disease in hypertensive patients is not very reliable. Because of the high rate of false-positive results the positive predictive value of electrocardiographic (ECG) exercise test is low.…”