The noninvasive diagnosis of coronary artery disease in hypertensive individuals is particularly challenging for the cardiologist, because the coexistence of hypertension dramatically lowers the specificity of exercise electrocardiography and perfusion scintigraphy. Experience with diagnostic tests in these patients has led to the frustrating conclusion in the pre-stress echocardiographic era that “no noninvasive screening test has been found to adequately discriminate between hypertensive patients with and without associated atherosclerosis.” Furthermore, all exercise-dependent tests also show a markedly lowered feasibility in hypertensive patients; severe hypertension during the resting condition is a contraindication to exercise testing, and even in mild-to-moderate hypertension the first step of exercise can induce an exaggerated hypertensive response that limits effort tolerance. Stress echocardiography tests have proven to have a higher specificity than ECG or perfusion stress testing, with a similar sensitivity. In addition, pharmacological stresses have a significantly higher feasibility than exercise stress testing, especially with vasodilator testing, which does not evoke the often limiting hypertensive response that can be associated with dobutamine stress. The exaggerated systolic blood pressure rise is also a frequent determinant of wall motion abnormalities during exercise, lowering the specificity of the test. Dipyridamole is less vulnerable to false-positive wall motion abnormalities since there is little or no systolic blood pressure rise during stress.
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Keywords
- Hypertensive Patient
- Left Ventricular Hypertrophy
- Coronary Flow Reserve
- Wall Motion Abnormality
- Stress Echocardiography
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Picano, E. (2009). Hypertension. In: Picano, E. (eds) Stress Echocardiography. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-76466-3_31
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