Diagnosing coronary artery disease in patients with hypertension: A resolved dilemma?

Patients with hypertension frequently complain of chest pain and exhibit ischemic-like ST segment changes on exercise electrocardiogram. However, the specificity of such changes for predicting significant coronary artery disease is very low, since these patients often exhibit a normal coronary angiogram. Several alternative non-invasive tests have been proposed and, recently, the relative performance of the available techniques has been systematically assessed. The purpose of this article is to review the relevant literature on the diagnostic tests employed in the clinical setting. Recent evidence suggests that stress echocardiography yields a better diagnostic accuracy than perfusion scintigraphy in identifying significant epicardial coronary artery disease in patients with hypertension. The low specificity of myocardial scintigraphy 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 axiomatically causing obvious wall motion abnormalities.