Detection of Coronary Disease in Patients With Hypertension: A Resolved Issue?
When patients with hypertension experience chest pain, exercise ECG ischemia-like ST segment changes are frequent and often falsely indicate significant coronary artery disease; these patients often have normal coronary angiograms. Several alternative noninvasive tests have been proposed, and recently, the relative accuracy and reliability of the available techniques have been assessed. We have reviewed some of the relevant literature on the diagnostic tests employed in the clinical setting, including recent reports that stress echocardiography as more accurate than perfusion scintigraphy in identifying significant epicardial coronary artery disease in patients with hypertension. The low specificity of myocardial scintigraphy, which measures cardiac function and wall motion abnormalities, probably relates to the fact that this method traces perfusion abnormalities not necessarily caused by epicardial coronary artery disease, possibly due to microvascular disease and not necessarily causing obvious wall motion abnormalities. (c)2000 by Le Jacq Communications, Inc.