morphologic hemodynamic and coronary perfusion characteristics in severe left ventricular hypertrophy secondary to systemic hypertension and evidence for nonatherosclerotic myocardial ischemia patients with the clinical diagnosis of ischemic heart disease who were found to be free of significant coronary artery atherosclerotic disease n 150 underwent coronary vasodilator reserve testing 2dimensional echocardiography and dipyridamole limitedstress thallium testing after exclusions predominantly for technically poor coronary artery doppler signals or suboptimal echocardiography 100 patients formed the study population the purpose was to characterize typical cardiac and coronary artery findings in hypertensive patients with severe left ventricular lv hypertrophy n 15 and to investigate the evidence for myocardial ischemia unrelated to coronary atherosclerosis in early and advanced hypertensive heart disease normotensive and hypertensive control groups without lv hypertrophy n 12 and 34 respectively were used for comparison severe lv hypertrophy was defined as lv mass index greater than or equal to 50 above established gender specific norms using 2dimensionaldirected mmode echocardiography and the cube equation corrected to agree with necropsy estimates of mass clinical characteristics more often associated with severe lv hypertrophy were black race 67 diabetes mellitus 33 proteinuria 47 and elevated creatinine 15 09 mgdl baseline electrocardiograms and dipyridamole limitedstress thallium scans were highly likely to be abnormal 94 and 73 respectively both eccentric and concentric cardiac hypertrophies were found in the severe group ejection fraction was significantly lower 051 vs 068 p 0002 and basal coronary flow velocity higher 120 vs 50 cms p 00004 among these patients when compared with normotensive control patients coronary flow reserve did not differ between control groups but was significantly depressed in patients with severe lv hypertrophy 25 vs 39 p 0001abstract truncated at 250 words