Vascular ventricular coupling in patients with malignant phase hypertension: the West Birmingham malignant hypertension project
Vascular ventricular coupling in patients with malignant phase hypertension: the West Birmingham malignant hypertension project
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DOI：
10.1038/hr.2012.18
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发表时间：
2012-07-01
影响因子：
5.4
通讯作者：
Lip, Gregory Y. H.
中科院分区：
文献类型：
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作者：
Shantsila, Alena;Dwivedi, Girish;Lip, Gregory Y. H.
尽管长期血压（BP）控制良好，但恶性高血压（MHT）患者仍存在持续性血管功能障碍，且临床预后比非MHT高血压患者差得多。我们假设与非 MHT 高血压对照相比，接受 MHT 治疗的患者存在异常动脉（动脉弹性（Ea）；动脉弹性指数（EaI））和心室（收缩末期弹性（Ees）和舒张末期弹性（Eed））弹性。对稳定 MHT 患者和接受治疗的“高危”高血压患者（HHT，但非 MHT）的心脏和血管硬度超声心动图参数（EaI、Ees 和 Eed）进行量化。所有患者的血压均得到良好控制，MHT 的中位随访时间为 144 个月。 Ea 根据每搏输出量和收缩压计算，并根据身体面积 (EaI) 进行调整。 Ees 是使用收缩压和舒张压、每搏输出量、射血分数、时间间隔和估计的动脉舒张末期标准化心室弹性来计算的。 Eed 是根据多普勒参数和舒张期充盈量计算的。两个研究组均保留左心室收缩力，3D超声心动图显示无显着差异（P=0.10）。EaI（P=0.83）、Ees（P=0.32）、Eed（P=0.23）和动心室相互作用（Ees/Ea，P=0.69）无显着差异。在MHT组中，Eed与年龄（r=0.56，P=0.38）和收缩压（r=0.68，P=0.008）呈正相关。在多变量回归分析中，MHT 状态不能预测心室和 Ea。尽管先前诊断为稳定型 MHT 的患者有血管功能障碍的记录，但动脉和收缩期弹性与 HHT 患者相似，这表明 MHT 患者适当的血压控制可以保留或恢复正常的动脉-心室耦合。高血压研究 (2012) 35, 725-728; doi：10.1038/hr.2012.18； 2012 年 2 月 23 日在线发布
Patients with malignant hypertension (MHT) have persistent vascular dysfunction and a much worse clinical prognosis than non-MHT hypertensive patients, despite good long-term blood pressure (BP) control. We hypothesized that abnormal arterial (arterial elastance (Ea); arterial elastance index (EaI)) and ventricular (End-systolic elastance (Ees) and End-diastolic elastance (Eed)) elastances are present in treated MHT patients, compared with non-MHT hypertensive controls. Echocardiographic parameters of cardiac and vascular stiffness (EaI, Ees and Eed) were quantified in patients with stable MHT and treated 'high-risk' hypertension patients (HHT, but non-MHT). All patients had well-controlled BP, with a median follow-up time for MHT of 144 months. Ea was calculated from stroke volume and systolic BP and adjusted by body area (EaI). Ees was calculated using systolic and diastolic BP, stroke volume, ejection fraction, time intervals and estimated normalized ventricular elastance at arterial end diastole. Eed was calculated from Doppler parameters and the diastolic filling volume. Both study groups had preserved left ventricular contractility, with no significant differences on 3D-echocardiography (P=0.10) There were no significant differences in EaI (P=0.83), Ees (P=0.32), Eed (P=0.23) and arterial-ventricular interaction (Ees/Ea, P=0.69). In the MHT group, Eed positively correlated with age (r=0.56, P=0.38) and systolic BP (r=0.68, P=0.008). On multivariable regression analysis, MHT status was not predictive of the ventricular and Ea. Despite documented vascular dysfunction in patients with previously diagnosed stable MHT, the arterial and systolic elastances were similar to HHT patients, suggesting that adequate BP control in MHT patients allows preservation or restoration of normal arterial-ventricular coupling. Hypertension Research (2012) 35, 725-728; doi:10.1038/hr.2012.18; published online 23 February 2012