Painless Myocardial Ischemia at Various Blood Pressure Levels in Patients With Effort Angina (J-Shaped Relationship).

摘要

Blood pressure (BP) elevation is associated with lowered sensitivity to pain and increased risk of painless myocardial ischemia. However relationship between frequency of episodes of symptomless myocardial ischemia and BP level in patients with normal or low BP has not been elucidated. In 74 men with ischemic heart disease and stable class I-III effort angina blood pressure was measured on the day of 24-hour ECG monitoring. Ranges of systolic (S) and diastolic (D) BP values were 93-159 and 65-104 mm Hg, respectively. Episodes of painless ischemia were most frequent in highest (4-th) (SBP>=142, DBP>=93 mm Hg) and least frequent in the 2nd (SBP 120-126, DAD 79-86 mm Hg.) quartile of BP distribution. In patients with lower BP (1st quartile) frequency of episodes of painless ischemia was significantly higher as compared with patients of the 2nd quartile. Thus relationship between frequency of episodes of painless ischemia and BP level in patients with stable effort angina was J-shaped: sensitivity to ischemia was lowered and frequency of painless ischemia increased both at highest and lowest values of BP.