Diagnosis of Coronary Artery Disease in Hypertensive Patients

Abstract

Diagnosis of atherosclerotic coronary artery disease in hypertensive patients is often difficult. In hypertensive patients angina may occur in the absence of significant coronary artery stenosis because of coronary microangiopathy and left ventricular hypertrophy. Results of exercise electrocardiographic stress test and Holter monitoring in hypertensive patients are frequently false positive. Left ventricular ejection fraction evaluated by radionuclide ventriculography often does not increase during exercise in hypertensive patients. Tomographic thallium-201 imaging is the excellent method of diagnosis of coronary artery disease, nevertheless in the presence of the left ventricular hypertrophy it often causes false positive results. In hypertensive patients with the symptoms of angina stress echocardiography (exercise or pharmacological) is highly accurate and significantly more specific method of diagnosis of coronary artery disease than exercise electrocardiographic test, independ- ently from the presence of left ventricular hypertrophy. The choice of noninvasive method of diagnosis of coronary artery disease according to sex, age and chest pain category is proposed.