PREVALENCE OF CORONARY ARTERY DISEASE IN YOUNG AND MIDDLE AGE PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION

Abstract

Objective: To establish the frequency of different forms of coronary artery disease (CAD) in patients with resistant arterial hypertension (AH). Methods: Based on the data from clinical and anamnestic studies and the results of electrocardiography (ECG), Holter ECG monitoring (HM-ECG), and bicycle ergometry (VEM), 370 young and middle-aged patients (WHO, 1965), the mean age 54.1±4, with primary AH were diagnosed with CAD according to the Canadian classification (World Health Organization (WHO), 1979; with additions by All-Union Cardiology Research Centre, 1995). With daily monitoring of blood pressure (BP) against the background of antihypertensive therapy (AHT), groups of patients with controlled (CAH; n=84) and resistant (RAH; n=286) arterial hypertension were identified. Results: It was found that in young and middle-aged patients with both CAH and RAH, the frequency of stable angina pectoris (SA) was the highest, mainly due to functional classes (FC) I-II; severe functional classes of SA, and unstable angina (UA) were markedly less frequent; less than a quarter of patients had a myocardial infarction (MI), mainly due to non-Q-wave MI (non-Q-MI). In patients with CAH and RAH FC I-II of SA were predominant (in 70.2% of patients with CAH and 34.3% with RAH; p=0.0001), while FC III-IV of SA were mainly observed against the background of RAH (21% vs. 5% in patients with CAH, p=0.0015). In patients of young and middle age, against the background of RAH, the frequency of UA (18.9%; p=0.0220) and the total number of MI (25.9%; p=0.0482) was higher, than in CAH, mainly due to Q-MI (11.2%; p=0.0360), indicating the severity of coronary insufficiency. The increase in non-Q-MI against the background of RAH was statistically insignificant (p=0.5191). Conclusion: The ratio of the frequency of different forms of CAD against the background of CAH and RAH was unidirectional. However, the overall frequency of severe forms of CAD (UA and MI, especially Q-MI) in patients with RAH significantly exceeded those in patients with CAH, which allowed us to consider RAH as a factor in the progressive course of CAD. Keywords: Coronary artery disease, stable angina, unstable angina, myocardial infarction, resistant arterial hypertension, young and middle age.