Myocardial perfusion abnormalities in treated hypertensive patients without known coronary artery disease

OBJECTIVE: 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. DESIGN: This study compares the prevalence and extent of rest and stress-induced myocardial perfusion abnormalities in patients with and without hypertension. METHODS: 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. RESULTS: 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). CONCLUSION: 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.