Non-invasive diagnostic testing for coronary artery disease in the hypertensive patient: Potential advantages of a risk estimation-based algorithm

Diana Chin, Allegra Battistoni, Giuliano Tocci, Jasmine Passerini, Gianfranco Parati, Massimo Volpe

Research output: Contribution to journalArticle

Abstract

Hypertension is a major risk factor for cardiovascular disease, including coronary atherosclerosis and its clinical manifestations. Non-invasive diagnosis of coronary artery disease in hypertension, however, remains a major clinical challenge. Chest pain frequently occurs in hypertensive patients with and without impairment of coronary blood flow supply. Electrocardiographic abnormalities are also common in these patients, thereby leading to further diagnostic difficulty. On the other hand, international guidelines are rather elusive on the recommended diagnostic pathway for coronary artery disease detection in hypertensive patients.In this article, we review the strengths and limitations of current diagnostic methods used to properly identifying coronary artery disease in hypertensive patients. Furthermore, we analyze the usefulness of adopting preliminary and comprehensive cardiovascular risk stratification, together with the evaluation of markers of organ damage, in order to improve the diagnostic efficacy.Despite the high prevalence of arterial hypertension, we still lack a strategy which would lead to validated and cost-effective clinical decision-making processes in hypertensive patients, which help clinicians to minimize useless, ineffective and expensive diagnostic steps. For this purpose, future guidelines should address the issue of diagnostic strategies for an early identification of hypertensive patients at risk of coronary artery disease. This may facilitate appropriate therapeutic choices to optimize the clinical management of coronary disease in hypertension.

Original languageEnglish
Pages (from-to)1226-1235
Number of pages10
JournalAmerican Journal of Hypertension
Volume25
Issue number12
DOIs
Publication statusPublished - Dec 2012

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Coronary Artery Disease
Hypertension
Guidelines
Chest Pain
Coronary Disease
Cardiovascular Diseases
Costs and Cost Analysis
Therapeutics

Keywords

  • arterial hypertension
  • blood pressure
  • cardiovascular prevention
  • cardiovascular risk stratification
  • coronary artery disease
  • global cardiovascular risk
  • hypertension

ASJC Scopus subject areas

  • Internal Medicine

Cite this

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abstract = "Hypertension is a major risk factor for cardiovascular disease, including coronary atherosclerosis and its clinical manifestations. Non-invasive diagnosis of coronary artery disease in hypertension, however, remains a major clinical challenge. Chest pain frequently occurs in hypertensive patients with and without impairment of coronary blood flow supply. Electrocardiographic abnormalities are also common in these patients, thereby leading to further diagnostic difficulty. On the other hand, international guidelines are rather elusive on the recommended diagnostic pathway for coronary artery disease detection in hypertensive patients.In this article, we review the strengths and limitations of current diagnostic methods used to properly identifying coronary artery disease in hypertensive patients. Furthermore, we analyze the usefulness of adopting preliminary and comprehensive cardiovascular risk stratification, together with the evaluation of markers of organ damage, in order to improve the diagnostic efficacy.Despite the high prevalence of arterial hypertension, we still lack a strategy which would lead to validated and cost-effective clinical decision-making processes in hypertensive patients, which help clinicians to minimize useless, ineffective and expensive diagnostic steps. For this purpose, future guidelines should address the issue of diagnostic strategies for an early identification of hypertensive patients at risk of coronary artery disease. This may facilitate appropriate therapeutic choices to optimize the clinical management of coronary disease in hypertension.",
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