Transient subendocardial ischemia in nifedipine abolition of hypertensive crises

Sublingual nifedipine, 30 mg, was used to abolish hypertensive crises in 32 patients. A follow-up of changes in blood pressure, ECG, and echocardiographic parameters evaluating the cardiac performance and central hemodynamics was performed during 4 hours after the drug. The patients with profound myocardial hypertrophy and dilatation at a left ventricular myocardial weight of over 200 g at the peak of the antihypertensive effect occurred for 15-60 min exhibited transient ECG changes by the type of subendocardial ischemia despite an above 25% reduction in mean blood pressure and the lack of severe reflex tachycardia, the pump function of the heart showing no decreases. The ejection fraction increased from 51.0 ± 2.8 to 62.0 ± 2.5% (p < 0.05) due to lower afterload. There were no clinical manifestations typical of myocardial ischemia.