Liebson PR
Section of Cardiology, Rush-Presbyterian-St. Luke's Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612, USA.
Curr Treat Options Cardiovasc Med. 1999 Oct;1(3):219-230. doi: 10.1007/s11936-999-0038-0.
The presence of left ventricular hypertrophy (LVH) as a treatable entity is of particular importance in patients with primary hypertension. Because LVH is associated with a strong risk of adverse clinical events (eg, heart failure, ischemic events, and cardiovascular death) and because evidence from retrospective studies suggests that regression of LVH, along with a decrease in blood pressure, may help modify these outcomes, the use of antihypertensive agents that have been shown to promote regression of LVH has been recommended. These include diuretics, beta-blockers (except those with intrinsic sympathomimetic activity ), angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, peripheral alpha(1)-blockers, and central alpha(2)-stimulators. Agents to be avoided include direct arterial vasodilators (eg, hydralazine and minoxidil), which have strong sympathetic stimulating properties and tend to maintain LVH despite lowering blood pressure. The use of ACE inhibitors is increasing. Unfortunately, the cost of these agents is higher than that of some other classes of agents, such as diuretics, which show excellent evidence of regression of hypertrophy. African-American and elderly persons, in particular, may benefit from diuretics for treatment of hypertension as well as reduction of left ventricular (LV) mass. Beta-blockers should be considered in the elderly, especially those with greatly thickened LV walls and small chamber sizes, factors associated with hyperdynamic systolic performance, systolic midcavity obliteration, and diastolic relaxation abnormalities on echocardiography. Calcium channel blockers may also be useful in patients with LVH who have normal systolic performance and diastolic compliance abnormalities. The purpose of serial echocardiographic studies in patients already being treated for hypertension is to ensure that LV geometry has not worsened and that function is unchanged or improved (especially with respect to previously noted diastolic Doppler inflow abnormalities). Considerable changes in estimated LV mass (>60 g on serial intrapatient evaluation) are needed before the clinician can conclude with confidence that LV mass has decreased. More specific definitive recommendations based on the outcomes of current large-scale clinical trials are awaited.
左心室肥厚（LVH）作为一种可治疗的病症，在原发性高血压患者中具有特别重要的意义。由于LVH与不良临床事件（如心力衰竭、缺血性事件和心血管死亡）的高风险相关，且回顾性研究证据表明LVH的消退以及血压的降低可能有助于改善这些结局，因此推荐使用已被证明可促进LVH消退的抗高血压药物。这些药物包括利尿剂、β受体阻滞剂（除具有内在拟交感活性的药物外）、血管紧张素转换酶（ACE）抑制剂、钙通道阻滞剂、外周α1受体阻滞剂和中枢α2受体激动剂。应避免使用的药物包括直接动脉血管扩张剂（如肼屈嗪和米诺地尔），它们具有强烈的交感神经刺激特性，尽管能降低血压，但往往会维持LVH。ACE抑制剂的使用正在增加。不幸的是，这些药物的成本高于其他一些药物类别，如利尿剂，利尿剂在肥大消退方面有充分的证据。特别是非裔美国人和老年人，使用利尿剂治疗高血压以及减少左心室（LV）质量可能会受益。对于老年人，尤其是那些LV壁明显增厚且腔室较小的患者，应考虑使用β受体阻滞剂，这些因素与超声心动图上的高动力收缩性能、收缩期心腔中部闭塞和舒张期松弛异常有关。钙通道阻滞剂对于LVH且收缩功能正常但存在舒张顺应性异常的患者也可能有用。对已接受高血压治疗的患者进行系列超声心动图研究的目的是确保LV几何形状没有恶化，功能未改变或有所改善（特别是对于先前发现的舒张期多普勒血流异常）。在临床医生能够自信地得出LV质量已降低的结论之前，估计LV质量需要有相当大的变化（在患者内系列评估中>60 g）。目前正在等待基于当前大规模临床试验结果的更具体明确的建议。
