Identifying which treated hypertensive patients without known coronary artery disease should be tested for the presence of myocardial ischemia by perfusion imaging

Abstract

Stress dipyridamole technetium-99(m) sestamibi single photon emission computed tomographic imaging was used to study myocardial perfusion in 1116 hypertensive patients without known coronary artery disease (CAD). The test confirmed the presence of CAD in 28.9% of patients. As expected, patients with diabetes mellitus (DM) had a significantly higher prevalence of myocardial perfusion abnormalities (35.9% vs 23.9%; odds ratio, 1.79; 95% confidence interval [CI], 1.38-2.33; P<.0001) and high-risk myocardial imaging (16.4% vs 10.6%; odds ratio, 1.67; 95% CI, 1.18-2.37; P=.004) than those without DM. Odd ratios further increased, again as expected, with dyslipidemia (2.19; 95% CI, 1.54-3.12; P<.0001), peripheral arterial disease (2.61; 95% CI, 1.77-3.85; P<.0001), microalbuminuria (3.03; 95% CI, 1.91-4.82; P<.0001), and abnormal electrocardiographic findings (3.06; 1.68; 95% CI, 2.08-4.48; P<.0001). This large cohort study showed that more than 1 of 4 treated hypertensive patients have subclinical CAD. These study data should be clinically helpful in selecting hypertensive patients who are the most suitable candidates to screen for the presence of CAD.

Figure 1

Frequency of type 2 diabetes mellitus (DM), dyslipidemia (DYSL), microalbuminuria (MICRO), smoking (SMK), abnormal resting electrocardiographic findings (ECG), and peripheral artery disease (PAD) in asymptomatic patients with a normal or an abnormal summed stress score (SSS).

Figure 2

Frequency (A) of abnormal summed stress score (SSS) and (B) high‐risk SSS in patients with hypertension (n=654) and in patients with essential hypertension (EH) and diabetes mellitus (DM) (n=462).

Figure 3

(A) Dipyridamole technetium‐99m sestamibi single photon emission computed tomographic study showing a normal myocardial perfusion image with normal summed stress score (SSS) and summed rest score (SRS). (B) An abnormal image showing ischemia (arrows) in the anterior, septal, and apical walls during stress that was partially reversible at rest with an SSS of 20, an SRS of 7, and a summed difference score of 13.

Figure 4

Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the presence of abnormal summed stress score (SSS) in patients with essential hypertension (EH) associated with other risk factors: dyslipidemia (DYSL), peripheral artery disease (PAD), abnormal resting electrocardiographic results (ECG), diabetes mellitus (DM), and microalbuminuria (MICRO). ^aOR associated with hypertensives without these risk factors, 1. + indicates presence; −, absence.

Figure 5

Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the presence of high‐risk summed stress score (SSS) in patients with hypertension associated with other risk factors: dyslipidemia (DYSL), peripheral artery disease (PAD), abnormal resting electrocardiographic results (ECG), diabetes mellitus (DM), and microalbuminuria (MICRO). ^aOR associated with hypertensives without these risk factors, 1. + indicates presence; −, absence.