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. 2010 Feb;24(2):77-85.
doi: 10.1038/jhh.2009.40. Epub 2009 May 21.

Impact of hypertension on coronary artery spasm as assessed with intracoronary acetylcholine provocation test

K-Y Chen  1 , S-W Rha, Y-J Li, K L Poddar, Z Jin, Y Minami, S Saito, J H Park, J O Na, C U Choi, H E Lim, J W Kim, E J Kim, C G Park, H S Seo, D J Oh
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Impact of hypertension on coronary artery spasm as assessed with intracoronary acetylcholine provocation test

K-Y Chen et al. J Hum Hypertens. 2010 Feb.

Abstract

Both hypertension and coronary artery spasm (CAS) are associated with endothelial dysfunction. Thus, a higher incidence of CAS is expected in hypertensive patients. We evaluated the impact of hypertension on CAS with intracoronary acetylcholine (ACh) provocation test. A total of 986 patients (685 hypertensive patients vs 301 normotensive patients) who underwent coronary angiography with ACh provocation test were enrolled. ACh was injected into the left coronary artery in incremental doses of 20, 50 and 100 microg min(-1). Significant CAS was defined as a transient >70% luminal narrowing with concurrent chest pain and/or ST-segment changes. Although the incidences of significant ACh-induced CAS were similar between hypertensive and normotensive patients (35.8 vs 39.2%, P=0.303), multivariate logistic analysis showed that hypertension was negatively associated with ACh-induced CAS (odds ratio: 0.70, 95% confidence interval: 0.51-0.94, P=0.020). The angiographic characteristics of ACh-induced CAS were similar between these two groups. Subgroup analysis regarding the impact of the status of blood pressure control on CAS showed that hypertensive patients with controlled blood pressure had a significantly higher incidence of CAS than those with uncontrolled blood pressure (45.2 vs 27.9%, P<0.001), and that uncontrolled blood pressure was negatively associated with ACh-induced CAS (odds ratio: 0.56, 95% confidence interval: 0.40-0.79, P=0.001). In conclusion, despite the expected endothelial dysfunction, hypertension and uncontrolled blood pressure are negatively associated with CAS, suggesting that the mechanisms and risk factors of CAS may be significantly different from those of coronary artery disease.

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Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Multivariate logistic analysis of the predictors for acetylcholine-induced significant coronary artery spasm in the general study population. ⧫: unadjusted odds ratio; ▪: adjusted odds ratio.
Figure 3
Figure 3
Multivariate logistic analysis of the predictors for acetylcholine-induced significant coronary artery spasm in hypertensive patients with vs without controlled blood pressure. ⧫: unadjusted odds ratio; ▪: adjusted odds ratio.
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