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European Heart Journal 1993 14(12):1622-1628;
Copyright © 1993 by the European Society of Cardiology.
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© 1993 The Europen Society of Cardiology

Left ventricular hypertrophy and myocardial ischaemia in hypertension: The THAMES Study

J. E. OTTERSTAD*,, M. DA VIES{dagger}, S. G. BALL{ddagger}, J. ERIKSSEN§, E. BIRKIN{ddagger}, S. VIRK{dagger}, S. E. RYNNING*, O. RODEVAND§, L. HANSSON||, A. BERGBRANDT||, I. FINDLAY, A. A. KHOKHAR, N. H. ARESKOG**, E. NYLANDER**, S. SMITH{dagger}{dagger} and H. F. MARLOW§§

*Medical Department, Vestfold Central Hospital Toensberg, Norway
{dagger}Department of Cardiovascular Medicine, Queen Elizabeth Hospital Birmingham U.K.
{ddagger}Department of Cardiovascular Studies, The University of Leeds U.K.
§Medical Department, Akershus Central Hospital Nordbyhagen, Norway
||Medical Department, Östra Sjukhuset Gothenburg Sweden
¶Department of Cardiovascular Medicine, The Royal Alexandra Hospital Paisley, Renfrewshire, U.K.
**Department of Clinical Physiology, University Hospital Linkoeping, Sweden
{dagger}{dagger}Department of Geriatrics, Royal Infirmary Liverpool, U.K.
§§Zeneca Pharmaceuticals Mereside, Alderley Park, Cheshire, U.K.

Received 11 January 1993; revised 24 June 1993; .

Correspondence J. E. Otterstad, MD. Medical Department, Vestfold Central Hospital, N-3100 Toensberg. Norway

Abstract

A multicentre epidemiological study to detect the prevalence of myocardial ischaemia in hypertensive left ventricular hypertrophy (LVH) was performed in 188 asymptomatic male hypertensives (131 treated). The mean age was 55 (range 40–82) years with blood pressure (BP) ≥160/100 mmHg or a systolic BP ≥ 180 mmHg. The participants were screened with echocardiography, and left ventricular hypertrophy (LVH), defined as LV mass index (LVMI) ≥ 130 g . m–2, was found in 127 (68%), of whom 95 were on antihypertensive treatment. Patients with LVH underwent a maximal bicycle ergometer exercise test and significant ST depression, indicating possible stress-induced ischaemia was found in 29 men (23%). These subjects were subjected to exercise thallium-201 scintigraphy, which was normal in 14 but showed reversible perfusion defects in 15.

Thus, a high prevalence of LVH (70%) was detected in male hypertensives selected only on age and BP. In addition, although chest pain on exertion excluded patients from entry, a substantial portion had signs of ischaemia (23% on exercise ECG alone, and in 52% confirmed by thallium scan). The prevalence of these risk factors should be considered when evaluating hyper tensive patients.

Key Words: Left ventricular mass index • bicycle ergometer exercise test • thallium scintigraphy


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