Silent Heart Attack Common In Asymptomatic Resistant Hypertension

Dr. Rodrigo Modolo Department of Pharmacology Faculty of Medical Sciences University of Campinas–UNICAMP Campinas, SP, Brazil; Interview with:
Dr. Rodrigo Modolo
Department of Pharmacology
Faculty of Medical Sciences University of Campinas–UNICAMP
Campinas, SP, Brazil;

Medical Research: What are the main findings of the study?

Dr. Modolo: The main findings of this study are the encounter of a high prevalence of silent myocardial ischemia (assessed by myocardial perfusion scintigraphy) in resistant hypertension and the identification of predictors of this alteration in this population.

Medical Research: Were any of the findings unexpected?

Dr. Modolo: In fact, all findings were expected. However, we did not know that in asymptomatic patients with resistant hypertension the prevalence of myocardial ischemia would be so high (28%).

Medical Research: What should clinicians and patients take away from your report?

Dr. Modolo: This is an interesting study in order to better guide clinicians in investigating their hypertensive patients to myocardial ischemia and coronary artery disease. Firstly because – as encountered – when the patient has true resistant hypertension, and is asymptomatic to any coronary disease alterations, the prevalence of ischemia is majorly high, justifying its investigation.

Not only that, but the identification of some alterations associated to myocardial ischemia can help clinicians in their investigation. For instance, in patients with resistant hypertension – even though asymptomatic – the presence of either elevated heart rate, microalbuminuaria or elevated ventricular mass (left ventricular hypertrophy) are strong indicators that they might present myocardial ischemia silently. This would allow clinicias to investigate and diagnose earlier this condition.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Modolo: As future researches in this area, I feel that a more vast cohort of resistant hypertension alterations (perhaps even a multicenter study with true resistant hypertension) could lead us to a better understanding of both silent and apparent myocardial ischemia.

Predictors of Silent Myocardial Ischemia in Resistant Hypertensive Patients

Modolo R1, de Faria AP2, Paganelli MO2, Sabbatini AR2, Barbaro NR2, Nascimento BB3, Ramos CD3, Fontana V2, Calhoun DA4, Moreno H2.
Am J Hypertens. 2014 Jul 25. pii: hpu140. [Epub ahead of print]