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Objectives-To systematically compare the results of dobutamine stress echocardiography in matched groups of hypertensive and normotensive patients with anginal chest pain and normal coronary arteriograms (CPNA).Setting-University hospital.Subjects-33 patients with exertional anginal chest pain, a positive exercise stress ECG, and a completely normal coronary arteriogram; 17 had a history of systemic hypertension (14 women; mean (SD) age 57 (6) years), and 16 had no hypertensive history (12 women; age 54 (9) years).Methods-Ambulatory ECG monitoring, dobutamine stress echocardiography, and thallium-201 single photon emission computed tomography (SPECT) were performed in all subjects.Results-All patients had normal left ventricular systolic function at rest and none fulfilled the criteria for ventricular hypertrophy.Eight normotensive patients and 10 hypertensive patients had perfusion abnormalities on thallium SPECT (p = 0.61).Dobutamine infusion reproduced anginal pain in seven normotensive and seven hypertensive patients (p = 0.88).ST segment depression was also recorded in eight normotensive patients and seven hypertensive patients (p = 0.61).No patient in either group developed regional wall motion abnormalities during dobutamine stress echocardiography.Conclusions-Neither hypertensive nor normotensive CPNA patients developed regional wall motion abnormalities during dobutamine stress echocardiography, despite the high prevalence of scintigraphic perfusion defects in both groups and the presence of chest pain and ST segment depression.Thus myocardial ischaemia was not present in either group, or else dobutamine stress echocardiography is insensitive to ischaemia caused by microvascular dysfunction.