Left ventricular hypertrophy and clinical outcomes in hypertensive patients
Left ventricular hypertrophy and clinical outcomes in hypertensive patients
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DOI：
10.1038/ajh.2008.16
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发表时间：
2008-05-01
影响因子：
3.2
通讯作者：
Schmieder, Roland E.
中科院分区：
文献类型：
--
作者：
Ruilope, Luis M.;Schmieder, Roland E.
左心室肥厚（LVH）的患病率随着高血压（HT）、年龄和肥胖的严重程度而升高。其患病率范围从轻度高血压患者的20%到重度或复杂HT患者的几乎100%。然而，LVH的诊断并不简单，临床研究中使用的定义和标准缺乏一致性。虽然许多因素在LVH的发病和进展中起作用，但血压（BP）被认为是一个中心因素。24小时血压测量与LVH的关系比在临床医生办公室进行的常规血压测量更密切。升高的肾素-血管紧张素系统（RAS）活性在LVH的发展中也起重要作用，各种研究表明血浆肾素活性与左心室质量（LVM）之间存在相关性。LVH是HT相关靶器官损伤的公认标志物，也是心血管（CV）不良结局的一个强而独立的风险因素。心血管风险随着左心室质量的增加而增加，随着抗高血压治疗后左心室肥厚的消退而降低。因此，检测、预防和逆转LVH是HT治疗的重要目标。大多数抗高血压药物可以降低血压和左室肥厚。然而，每种药物类别可能在不同程度上诱导LVH消退，并且这些程度很少与所实现的BP降低程度相关。这一领域为数不多的大型比较研究的数据表明，某些类别的抗高血压药物和/或其组合比其他药物更有效。特别是，钙通道阻滞剂和靶向RAS的药物，如血管紧张素转换酶抑制剂（ACEIs）和血管紧张素受体阻滞剂（ARB），似乎对LVH有特异性作用，与血压降低无关。因此，指南推荐这些药物类别用于治疗伴有LVH的高血压患者。
The prevalence of left ventricular hypertrophy (LVH) rises with severity of Hypertension (HT), age, and obesity. Its prevalence ranges from 20% in mildly hypertensive patients to almost 100% in those with severe or complicated HT. However, the diagnosis of LVH is not straightforward, and the definitions and criteria used in clinical studies lack consistency. While many factors play a role in the onset and progression of LVH, blood pressure (BP) is recognized as a central factor. Twenty-four-hour BP measurements are more closely related to LVH than conventional BP readings taken in the clinician's office. Increased renin-angiotensin system (RAS) activity also plays an important role in the development of LVH, and various studies show a correlation between plasma renin activity and left ventricular mass (LVM). LVH is a recognized marker of HT-related target organ damage, and a strong and independent risk factor for adverse cardiovascular (CV) outcomes. CV risk increases with increasing LVM, and decreases with regression of LVH in response to anti hypertensive treatment. Therefore the detection, prevention, and reversal of LVH are important goals in HT management. Most anti hypertensive drugs can attenuate BP and LVH. However, each drug class may induce LVH regression to a different extent and these extents seldom correlate with the degree of BP reduction achieved. Data from the few large comparative studies in this area suggest that certain classes of antihypertensive drugs and/or their combinations are more effective than others. In particular, calcium channel blockers and drugs that target the RAS, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), appear to have a specific effect on LVH, independent of BP reduction. Guidelines, therefore, have recommended these drug classes for the treatment of hypertensive patients with LVH.