Ghanem Wisam M A, Murín J, Bulas J
I. interná klinika, Fakultná nemocnica a LF UK, Bratislava.
Vnitr Lek. 1999 Jul;45(7):421-8.
The left ventricular hypertrophy is a risk marker of the cardiovascular morbidity and mortality in hypertensive patients--it contributes to sudden death, myocardial infarction, myocardial ischemia, heart failure, arrhythmias, left ventricular diastolic dysfunction, stroke and renal failure. The mechanisms by which the heart hypertrophy increases the risk of cardiovascular morbidity and mortality, however, is not completely clear yet. Pressure overload (resulting in the concentric hypertrophy) and volume overload (resulting in the eccentric hypertrophy) of the left ventricle play a significant role in the development of the hypertrophy of the left ventricle. Other risk factors, stimulating left ventricular hypertrophy, include growth factors, genetic predisposition, age, obesity, hyperinsulinemia and anemia. The hypertrophy of left ventricle most often occurs with hypertension, cardiomyopathy and aortic stenosis. Several clinical studies evaluated functional consequences of the reduction of the ventricular hypertrophy and found out that the function of the left ventricle to be improved in hypertensive patients who had undergone an effective and long-term antihypertensive treatment. However, these studies did not differentiate whether for the improvement in the function of left ventricle was the matter of the reduction of the left ventricular mass or whether it was because of the decrease of the arterial pressure during the period of anti-hypertensive treatment. On the basis of the literature studied we can emphasize that the reduction of myocardial hypertrophy resulting from a specific antihypertensive treatment appears to be more favourable than harmful for the heart's pump performance.
左心室肥厚是高血压患者心血管发病和死亡的风险标志物——它会导致猝死、心肌梗死、心肌缺血、心力衰竭、心律失常、左心室舒张功能障碍、中风和肾衰竭。然而,心脏肥厚增加心血管发病和死亡风险的机制尚不完全清楚。左心室压力超负荷(导致向心性肥厚)和容量超负荷(导致离心性肥厚)在左心室肥厚的发展中起重要作用。其他刺激左心室肥厚的危险因素包括生长因子、遗传易感性、年龄、肥胖、高胰岛素血症和贫血。左心室肥厚最常发生于高血压、心肌病和主动脉瓣狭窄。多项临床研究评估了减轻心室肥厚的功能后果,发现接受有效长期降压治疗的高血压患者左心室功能得到改善。然而,这些研究没有区分左心室功能的改善是由于左心室质量的减轻,还是由于降压治疗期间动脉压的降低。基于所研究的文献,我们可以强调,特定降压治疗导致的心肌肥厚减轻对心脏泵功能似乎利大于弊。