Diagnosis of myocardial ischemia in hypertensive patients

Eugenio Picano, Attila Pálinkás, Robert Amyot

Research output: Contribution to journalReview article

106 Citations (Scopus)


Arterial hypertension can provoke a reduction in coronary flow reserve through several mechanisms that are not mutually exclusive (i.e. epicardial coronary artery disease (CAD), left ventricular hypertrophy and structural and/or functional microvascular disease). These different targets of arterial hypertension should be explored with different diagnostic markers. In fact, stress-induced wall motion abnormalities are highly specific for angiographically assessed epicardial CAD, whereas ST segment depression and/or myocardial perfusion abnormalities are frequently found with angiographically normal coronary arteries associated with left ventricular hypertrophy and/or microvascular disease. Exercise-electrocardiography stress test can be used to screen patients with negative maximal test due to its excellent negative predictive value, which is high and comparable in normotensives and hypertensives. When exercise-electrocardiography stress test is positive (or uninterpretable or ambiguous), an imaging stress-echo test is warranted for a reliable identification of significant, prognostically malignant epicardial CAD in view of an ischemia-guided revascularization.

Original languageEnglish
Pages (from-to)1177-1183
Number of pages7
JournalJournal of hypertension
Issue number7
Publication statusPublished - Jan 1 2001


  • Diagnosis
  • Echocardiography
  • Electrocardiography
  • Ischemia

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

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