From the Guidelines
Hypertension can indeed cause chest discomfort, as it may lead to subendocardial ischemia due to left ventricular hypertrophy and increased afterload. This is supported by a study published in the European Heart Journal in 2015 1, which highlights the challenges of diagnosing coronary artery disease in patients with hypertension. According to this study, chest pain in patients with hypertension may signify concurrent coronary artery disease or may simply reflect subendocardial ischemia due to left ventricular hypertrophy and increased afterload. Some key points to consider include:
- The diagnosis of coronary artery disease has particular challenges in this setting, because ‘false-positive’ results may occur when subendocardial ischemia causes abnormal stress ECG or myocardial perfusion scan in the absence of flow-limiting epicardial coronary disease.
- A normal stress electrocardiogram, performed to a high workload, has a high negative predictive value, but an abnormal or ambiguous test warrants further evaluation.
- There is some evidence in favour of preferential use of stress echocardiography for this purpose, because stress-induced wall motion abnormalities are highly specific for coronary artery disease, while perfusion defects in hypertensive patients may arise from abnormal myocardial flow reserve not due to epicardial coronary disease. It's essential to note that chest pain could also indicate more serious conditions like heart attack, so any unexplained chest discomfort should be evaluated promptly by a healthcare provider. Managing hypertension through medication, regular exercise, reduced sodium intake, stress management, and maintaining a healthy weight can help reduce the risk of chest discomfort and other complications, as supported by the study 1.
From the Research
Hypertension and Chest Discomfort
- Hypertension is a major modifiable risk factor for all clinical manifestations of coronary artery disease (CAD) 2
- High blood pressure can cause chest discomfort due to its effects on the cardiovascular system, including the development of atherosclerotic plaques and increased pulse pressure 2
- The pathophysiology of essential hypertension involves increased cardiac output and/or increased peripheral resistance, which can lead to chest discomfort 3
Relationship between Hypertension and Chest Pain
- Chest pain is a frequent symptom in patients with pulmonary arterial hypertension (PAH) 4
- Left main coronary artery (LMCA) extrinsic compression from a pulmonary artery (PA) is a recognized cause of angina or complications in patients with PAH 4
- Treatment of arterial hypertension has been proven to prevent coronary events in patients without clinical CAD, and may also reduce the risk of chest discomfort 2
Clinical Outcomes and Hypertension
- The use of sacubitril-valsartan versus angiotensin converting enzyme inhibitor or angiotensin receptor blocker has been shown to improve clinical outcomes among patients with heart failure and ejection fraction at/less than 60% 5
- However, the relationship between sacubitril-valsartan use and chest discomfort is not directly addressed in the available evidence 5
- Further research is needed to fully understand the relationship between hypertension, chest discomfort, and clinical outcomes 6, 4, 2, 3, 5