Muiesan M L, Salvetti M, Monteduro C, Corbellini C, Guelfi D, Rizzoni D, Castellano M, Agabiti-Rosei E
Department of Medical and Surgical Sciences, Internal Medicine, University of Brescia, Italy.
J Hypertens. 2001 Mar;19(3 Pt 2):641-7. doi: 10.1097/00004872-200103001-00018.
In arterial hypertension, the spectrum of geometric patterns in the left ventricle may parallel the structural alterations detected in the carotid arteries and in subcutaneous small arteries. It has been also reported that hypertensive left ventricular hypertrophy (LVH) may be associated with endothelial dysfunction, as evaluated by the response of coronary or forearm vasculature to acetylcholine infusion. The aim of this study was to evaluate the flow-mediated vasodilatation (FMD) of the brachial artery, non-invasive estimate of endothelium-dependent vasodilatation according to left ventricular geometric adaptations in hypertensive patients.
In 16 normotensive (nine males, seven females, aged 40-68 years) and in 78 hypertensive subjects (50 males, 28 females, aged 42-67 years), we performed an echocardiographic study for the measurement of left ventricular mass index (LVMI) and relative wall thickness (RWT); we measured to a high resolution the brachial artery diameter at rest, during reactive hyperaemia (5 min of brachial artery occlusion) and after sublingual glyceril trinitrate (GTN); brachial artery flow velocity was measured by pulsed Doppler. Twenty-six hypertensive patients had a normal LVMI (LVMI < 51 g/ m2.7) and geometry (RWT < 0.44), five had concentric remodelling (RWT > or = 0.44), and concentric and eccentric LVH were observed in 19 and 28 patients, respectively. FMD was reduced in hypertensive patients as compared with normotensive subjects (P< 0.01). No correlation was found between FMD and LVMI (r= -0.078) or RWT (r = 0.049); in addition, no difference in FMD was found among the left ventricular geometric patterns in hypertensive patients.
In hypertensives, the presence of endothelial dysfunction is not associated with the LVH or with different left ventricular geometric patterns, suggesting that different and independent mechanisms may be responsible for the presence of LVH and of endothelial dysfunction.
在动脉高血压中，左心室几何形态的变化可能与在颈动脉和皮下小动脉中检测到的结构改变相似。也有报道称，通过冠状动脉或前臂血管对乙酰胆碱输注的反应评估，高血压性左心室肥厚（LVH）可能与内皮功能障碍有关。本研究的目的是根据高血压患者左心室几何形态适应性，评估肱动脉的血流介导的血管舒张功能（FMD），这是一种非侵入性的内皮依赖性血管舒张功能评估方法。
对16名血压正常者（9名男性，7名女性，年龄40 - 68岁）和78名高血压患者（50名男性，28名女性，年龄42 - 67岁）进行了超声心动图检查，以测量左心室质量指数（LVMI）和相对壁厚（RWT）；我们以高分辨率测量了静息时、反应性充血期间（肱动脉闭塞5分钟）和舌下含服硝酸甘油（GTN）后肱动脉直径；通过脉冲多普勒测量肱动脉流速。26名高血压患者的LVMI正常（LVMI < 51 g/m².⁷）且几何形态正常（RWT < 0.44），5名患者有向心性重构（RWT ≥ 0.44），分别在19名和28名患者中观察到向心性和离心性LVH。与血压正常者相比，高血压患者的FMD降低（P < 0.01）。未发现FMD与LVMI（r = -0.078）或RWT（r = 0.049）之间存在相关性；此外，高血压患者不同左心室几何形态之间的FMD无差异。
在高血压患者中，内皮功能障碍的存在与LVH或不同的左心室几何形态无关，这表明LVH和内皮功能障碍的存在可能由不同且独立的机制所致。
