Schmieder R E, Messerli F H
Department of Medicine IV, University of Erlangen-Nürnberg, Germany.
J Hum Hypertens. 2000 Oct-Nov;14(10-11):597-604. doi: 10.1038/sj.jhh.1001044.
It has been clearly demonstrated that left ventricular (LV) hypertrophy is a strong blood pressure independent risk factor for cardiovascular morbidity and mortality in the general population, in primary and secondary hypertension and in cardiac patients. LV hypertrophy in arterial hypertension develops in response to an increased afterload, but underlying pathophysiological mechanisms include a variety of non-haemodynamic factors. Due to the prognostic importance of LV hypertrophy, normalisation of LV mass emerged as a desirable goal of antihypertensive treatment. Indeed, several prospective studies now indicate that regression of LV hypertrophy reduced cardiovascular complications. As a consequence, the question was raised whether certain antihypertensive drugs differ in their ability to reduce LV mass. Several comparative studies and meta-analyses have been carried out to resolve this issue. The available data seem to indicate that angiotensin-converting enzyme (ACE)-inhibitors and calcium channel blockers were more potent than beta-blockers in their ability to reduce LV hypertrophy, with diuretics in the intermediate range. The role of new antihypertensive agents such as angiotensin II AT1-receptor blockers appears similar to the one of ACE-inhibitors, since in some studies angiotensin II AT1-receptor blockers were superior to beta-blockers and diuretics. Various aspects of LV hypertrophy including its prevalence, determinants, prognosis and regression are discussed in this article.
已有明确证据表明，左心室（LV）肥厚是普通人群、原发性和继发性高血压患者以及心脏病患者发生心血管疾病和死亡的一个与血压无关的重要危险因素。动脉高血压患者的左心室肥厚是对后负荷增加的一种反应，但其潜在的病理生理机制包括多种非血液动力学因素。鉴于左心室肥厚对预后的重要性，使左心室质量恢复正常成为降压治疗的一个理想目标。事实上，目前多项前瞻性研究表明，左心室肥厚的消退可减少心血管并发症。因此，人们提出了一个问题，即某些降压药物在减轻左心室质量的能力上是否存在差异。为解决这一问题，已经开展了多项比较研究和荟萃分析。现有数据似乎表明，血管紧张素转换酶（ACE）抑制剂和钙通道阻滞剂在减轻左心室肥厚方面比β受体阻滞剂更有效，利尿剂的效果处于中等水平。新型降压药物如血管紧张素II AT1受体阻滞剂的作用似乎与ACE抑制剂相似，因为在一些研究中，血管紧张素II AT1受体阻滞剂优于β受体阻滞剂和利尿剂。本文将讨论左心室肥厚的各个方面，包括其患病率、决定因素、预后和消退情况。
