Studies on left ventricular hypertrophy regression in arterial hypertension:: A clear message for the clinician?
Studies on left ventricular hypertrophy regression in arterial hypertension:: A clear message for the clinician?
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DOI：
10.1038/ajh.2007.85
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发表时间：
2008-04-01
影响因子：
3.2
通讯作者：
Mancia, Giuseppe
中科院分区：
文献类型：
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作者：
Cuspidi, Cesare;Esposito, Arturo;Mancia, Giuseppe
背景循证医学应该向临床医生提供清晰且公正的信息。我们对已发表的随机试验进行了分析，评估抗高血压治疗对超声心动图评估的左心室 (LV) 形态的影响，以调查 (i) 左心室肥厚 (LVH) 定义标准的一致性和 (ii) LVH 回归和血压 (13P) 控制报告方式的一致性。方法 PubMed 检索确定的研究如果满足以下标准，则有资格纳入分析： (i) 在过去 12 年内在同行评审期刊上发表过文章； (ii) 双盲、随机、对照、平行组设计； (iii) 至少 50 名成人高血压受试者的数量； (iv) 至少 6 个月的随访时间； (v) 单一药物或联合治疗方案之间的比较； (vi) 通过超声心动图测量左心室质量 (LVM) 或壁厚度。 结果 确定了 39 项试验，包括 78 个有效治疗组或 6 个安慰剂组中的 9,162 名男女高血压受试者。 34 项研究 (87.1%) 根据 19 项不同标准提供了 LVH 的定义。所有试验均将 LVH 回归评估为连续变量（如 LVM 指数 (LVMI) 或 LV 壁厚度）的绝对或相对变化。 12 项研究报告了有关 LVM 正常化发生率的数据 (30.7%)。 11 项研究 (28.2%) 报告了达到血压目标 (< 140/90 mm Hg) 的患者百分比。 结论 我们的研究结果表明 (i) 高血压 LVH 表型的定义差异极大，(ii) 大多数论文没有提供有关 LVH 消退率或 LV 几何模式变化以及目标血压的精确信息。
BACKGROUND Evidence-based medicine should provide clear and unbiased information to clinicians. We conducted an analysis on published randomized trials evaluating the effects of anti hypertensive therapy on left ventricular (LV) morphology assessed by echocardiography to investigate (i) the consistency of criteria used for definition of LV hypertrophy (LVH) and (ii) the consistency of the way LVH regression and blood pressure (13P) control were reported. METHODS Studies identified by a PubMed search were eligible for inclusion in the analysis, if they fulfilled the following criteria: (i) publication in a peer-reviewed journal within the last 12 years; (ii) double blind, randomized, controlled, parallel-group design; (iii) numerosity of at least 50 adult hypertensive subjects; (iv) follow-up duration of at least 6 months; (v) comparison between single-drugs or association regimens; (vi) LV mass (LVM) or wall thickness measured by echocardiography.RESULTS Thirty-nine trials, including 9,162 hypertensive subjects of both genders in 78 active treatment arms or in 6 placebo arms were identified. Definition of LVH was provided by 34 studies (87.1 %) according to 19 different criteria. All trials evaluated LVH regression as the absolute or relative changes of continuous variables such as LVM index (LVMI) or LV wall thickness. Data concerning prevalence rates of LVM normalization were reported in 12 studies (30.7%). The percentage of patients reaching BP target (< 140/90 mm Hg) was reported in 11 studies (28.2%).CONCLUSIONS Our findings indicate that (i) definition of hypertensive LVH phenotype is extremely variable, and (ii) no precise information on LVH regression rates or changes in LV geometrical patterns, as well as on target BP, is provided by the majority of papers.