RELATION OF OBESITY AND GENDER TO LEFT-VENTRICULAR HYPERTROPHY IN NORMOTENSIVE AND HYPERTENSIVE ADULTS
RELATION OF OBESITY AND GENDER TO LEFT-VENTRICULAR HYPERTROPHY IN NORMOTENSIVE AND HYPERTENSIVE ADULTS
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DOI：
10.1161/01.hyp.23.5.600
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发表时间：
1994-05-01
期刊：
影响因子：
8.3
通讯作者：
LARAGH, JH
中科院分区：
文献类型：
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作者：
DESIMONE, G;DEVEREUX, RB;LARAGH, JH
虽然认识到高血压和肥胖都与左心室重量增加有关，但肥胖、动脉高血压和性别对左心室肥厚患病率的相对影响仍不确定。因此，对164名正常血压受试者(85名男性[24名肥胖]和79名女性[28名肥胖]，年龄45+/-12岁)和475名高血压患者(325名男性[126名肥胖]和150名女性[85名肥胖]，年龄54+/-10岁)进行了超声心动图左心室质量与身高的异速生长或生长关系的比较。使用特定性别的正常上限来识别心肌肥厚。与血压水平无关，肥胖者的左心室质量/高度(2.7)高于正常体重的正常血压受试者(P<；.004)，肥胖者肥厚(主要是偏心性)的发生率高于正常体重的正常血压受试者(14%对5%，P<；.04)，这种差异不是通过左心室质量/体表面积来检测到的。左心室质量/高度(2.7)在52%的肥胖者和30%的正常体重的高血压患者中被诊断为肥厚(P<；0.0001)，因为肥胖者中离心性和向心性室壁肥厚的患病率均高于正常体重患者(34%对20%，18%对10%)。在血压正常的肥胖女性(而不是男性)中，左心室质量的增加与血压值无关，高血压肥胖女性(58%)的左心室质量/身高超常的发生率(2.7)甚至高于男性(49%)。Logistic分析显示，体重指数是整个人群或仅高血压患者左心室肥厚的主要预测因子(P<；0.0001，无论男女)，血压的影响较小，尤其是在女性。总而言之，在血压正常的情况下，肥胖是对心肌生长的独立刺激，而在高血压存在的情况下，肥胖的影响至少与高血压相加。肥胖对心脏解剖的影响女性大于男性，特别是在存在动脉高血压的情况下。
Although it is recognized that both hypertension and obesity are associated with increased left ventricular mass, the relative impacts of obesity, arterial hypertension, and gender on the prevalence of ventricular hypertrophy remain uncertain. Accordingly, echocardiographic left ventricular mass normalized for height to the power of the allometric or growth relation between ventricular mass and height was compared in 164 normotensive subjects (85 men [24 obese] and 79 women [28 obese], aged 45 +/- 12 years) and 475 hypertensive patients (325 men [126 obese] and 150 women [85 obese], aged 54 +/- 10 years) from an adult employed population. Gender-specific upper normal limits were used to identify ventricular hypertrophy. Left ventricular mass/height(2.7) was higher in obese than normal-weight normotensive subjects (P < .004) independently of the level of blood pressure and identified a higher prevalence of hypertrophy (mainly eccentric) in obese than in normal-weight normotensive subjects (14% versus 5%, P < .04), a difference that was not detected by left ventricular mass/body surface area. Left ventricular mass/height(2.7) identified hypertrophy in 52% of obese and 30% of normal-weight hypertensive patients (P < .0001) because of higher prevalences in obese than normal-weight patients of both eccentric (34% versus 20%) and concentric ventricular hypertrophy (18% versus 10%). The increase in left ventricular mass was independent of blood pressure values in obese normotensive women (but not men), and the prevalence of supranormal left ventricular mass/height(2.7) was even higher in hypertensive obese women (58%) than men (49%). Logistic analysis showed that body mass index was the main predictor of left ventricular hypertrophy in the entire population or hypertensive patients only (P < .0001 in both genders) and that the effect of blood pressure was smaller, especially in women. In conclusion, obesity is an independent stimulus to myocardial growth in the presence of normal blood pressure, and its effect is at least additive to that of high blood pressure in the presence of hypertension. The effect of obesity on cardiac anatomy is greater in women than in men, especially in the presence of arterial hypertension.