Tucker B, Fabbian F, Giles M, Johnston A, Baker L R
Department of Nephrology, St. Bartholomew's Hospital, London, UK.
Clin Nephrol. 1999 Dec;52(6):377-82.
We have reported previously in a study of 85 non-diabetic patients with chronic renal failure (CRF) that 24-h ambulatory blood pressure (ABP) recording and echocardiography are required for accurate diagnosis of inadequate blood pressure (BP) control and early left ventricular hypertrophy (LVH). In this study we found that the only independent determinants of left ventricular (LV) mass were hypertension, male sex, body mass index (BMI) and anemia. Little is known about the progression of LVH in patients as they progress from moderate to end-stage renal failure.
We undertook a follow-up observational study in a cohort of 65 (26 male, 12 black Afro-Caribbean and 7 Asian) of those patients originally investigated. Patients who had reached end-stage renal failure (ESRF) were not studied.
A statistically significant correlation was found between change in left ventricular mass index (LVMI) and change in mean ABP parameters (r = 0.27 (p<0.03) for 24-h systolic, r = 0.21 (p<0.05) for 24-h diastolic, r = 0.29 (p<0.02) for mean arterial pressure (MAP), r = 0.24 (p<0.05) for daytime systolic, r = 0.30 (p<0.02) for nocturnal systolic and r = 0.26 (p<0.05) for nocturnal diastolic BP). Hemoglobin concentration and BMI changed little between the two studies and no other statistically significant correlations were found in respect of any other parameters studied, which has allowed us to isolate the effect of one determinant - adequacy of BP control-upon LVH.
In patients with moderate chronic renal impairment, reduction in BP is associated with reduction of LVMI over time. Among the antihypertensive agents ACE inhibitors appeared to have the greatest ability to reduce LV mass in the subjects with LVH at baseline. Larger interventional studies are needed to determine whether ACE inhibitors are superior to other anti-hypertensive agents in LVH regression in chronic renal failure patients.
我们先前在一项对85例非糖尿病慢性肾衰竭（CRF）患者的研究中报告，准确诊断血压（BP）控制不佳和早期左心室肥厚（LVH）需要进行24小时动态血压（ABP）记录和超声心动图检查。在本研究中，我们发现左心室（LV）质量的唯一独立决定因素是高血压、男性、体重指数（BMI）和贫血。对于患者从中度肾衰竭进展到终末期肾衰竭过程中LVH的进展情况，人们了解甚少。
我们对最初研究的65例患者（26例男性、12例非洲加勒比黑人及7例亚洲人）进行了一项随访观察研究。已达到终末期肾衰竭（ESRF）的患者未纳入研究。
左心室质量指数（LVMI）变化与平均ABP参数变化之间存在统计学显著相关性（24小时收缩压r = 0.27（p<0.03），24小时舒张压r = 0.21（p<0.05），平均动脉压（MAP）r = 0.29（p<0.02），日间收缩压r = 0.24（p<0.05），夜间收缩压r = 0.30（p<0.02），夜间舒张压r = 0.26（p<0.05））。两次研究之间血红蛋白浓度和BMI变化不大，在所研究的任何其他参数方面未发现其他统计学显著相关性，这使我们能够分离出一个决定因素——BP控制的充分性——对LVH的影响。
在中度慢性肾功能损害患者中，随着时间推移，血压降低与LVMI降低相关。在基线时有LVH的受试者中，血管紧张素转换酶（ACE）抑制剂似乎具有最大的降低LV质量的能力。需要进行更大规模的干预性研究，以确定ACE抑制剂在慢性肾衰竭患者LVH消退方面是否优于其他抗高血压药物。
