PURPOSE: To evaluate the diagnosis value of exercise testing for silent myocardial ischemia in systolic hypertension of the elderly. METHODS: We compared 110 patients with systolic hypertension (group A) with 104 patients without hypertension (group B). They were submitted to an exercise test according to the Bruce protocol, between January/91 to December/94. Exercise was discontinued if target heart rate was achieved, or fatigue, dyspnea, severe arrhythmia, hypotension or significant ST segment depression >2mm/0.2mV developed. RESULTS: Exercise testing showed ischemic ST depression in 22 (20%) of the elderly patients with hypertension systolic and 12 (11.5%) of control elderly patients. The exercise time was shorter in the hypertensives 7.1±2.9min vs 8.8±2.5min. The ST depression was greater in the hypertensives than the control group: 2.5±0.8min vs 1.9±0.4min. Also the duration or ischemic ST depression was longer in the hypertensive patients than the control group 5.4±2.8min vs 3.4±1.9min. CONCLUSION: Elderly hypertensive patients with systolic hypertension have more silent myocardial ischemia than elderly without hypertension. Among the elderly hypertensive patients there was a prevalence of silent ischemia that was 1.7 times higher than in the normotensive elderlies (20% vs 11.5% P<0.003).