Relationship between arterial pressure and exertional angina pectoris in hypertensive patients.

E LEVATION of arterial pressure has been found in patients during attacks of angina pectoris1-3 and relief of exertional angina has been reported in hypertensive patients following satisfactory control of hypertension.4' 5 Further, anginal pain has been found to occur in hypertensive patients during lowering of arterial pressure.4 Although these observations suggest an etiologic correlation between angina pectoris and level of arterial pressure, this has not been adequately established. The present study was undertaken to determine the possible relationship between arterial pressure and exertional angina pectoris in hypertensive patients with and without coronary arterial disease. Methods Seven hypertensive patients (four women and three men) in the Research Ward of the Cleveland Clinic Hospital with unequivocal history of exertional angina pectoris of the functional class II were studied. Coronary arteriography by Sones' technic ;6 revealed segmental disease of the left coronary artery in four and of both coronary arteries in one (fig. 1); the remaining two were found to have normal coronary arteries (fig. 2). Radiographic, as well as electrocardiographic, evidence of left ventricular hypertrophy was present in all. None had a history or electrocardiographic evidence of recent or remote myocardial infarction. The five patients with coronary arterial disease had not taken any antihypertensive treatment prior to the study and during the study had moderate to severe hypertension; the two patients with normal coronary arteries had received guanethidine