Relationship between Arterial Pressure and Exertional Angina Pectoris in Hypertensive Patients

Seven hypertensive patients, five with coronary arterial disease and two with normal coronary arteries, with exertional angina pectoris and left ventricular hypertrophy were subjected to exercise in the sitting and supine position. The five patients with coronary arterial disease developed, during exercise in both positions, striking arterial pressure elevation followed by angina pectoris and electrocardiographic changes. When the pressor response to exercise was eliminated by intravenous sodium nitroprusside, these were prevented. In the two patients with normal coronary arteries who had orthostatic and exertional hypotension secondary to antihypertensive treatment, exercise in the sitting position caused intense hypotension followed by angina pectoris and electrocardiographic changes. In contrast, exercise in the supine position, which caused only minimal pressure changes, was not followed by angina pectoris. It is concluded that in hypertensive patients with coronary arterial disease, further elevation of arterial pressure during exercise is an important factor in precipitating angina pectoris by increasing cardiac work. In hypertensive patients with normal coronary arteries and exertional hypotension secondary to antihypertensive treatment, marked lowering of arterial pressure during exercise is a factor of importance in producing angina pectoris, probably by reduction of perfusion pressure and coronary flow relative to the hypertrophied left ventricle.