Koren Michael J, Ulin Roy J, Koren Andrew T, Laragh John H, Devereux Richard B
Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York, USA.
Am J Hypertens. 2002 Dec;15(12):1021-8. doi: 10.1016/s0895-7061(02)03061-3.
It is uncertain whether reduction of left ventricular (LV) mass during antihypertensive treatment predicts reduces cardiovascular complications of hypertension.
A total of 172 prospectively identified patients with essential hypertension without complications of hypertension at baseline and follow-up echocardiograms 5.5 +/- 3.0 years apart, were followed an additional 4.8 +/- 2.9 years. Antihypertensive treatment was determined by primary physicians.
After the second echocardiograms, cardiovascular events occurred in 24 patients (14%). Fewer of the 91 patients with unchanged or decreased LV mass experienced cardiovascular events than of the 81 patients whose LV mass increased during follow-up (8.8% [95% confidence interval (CI): 3.9%-13.7%] v 19.8% [95% CI 12.6%-27.0%]; P =.04) despite greater baseline LV mass in the former group (118 g/m(2) [95% CI 111-125] v 95 g/m(2) [95% CI 88-102]; P <.0001). Absence or presence of LV hypertrophy on the follow-up echocardiogram was the strongest predictor of relatively low (9.2% [95% CI 5%-13.4%]) v high (28.6% [95% CI 17.1%-40.1%]; P =.004) rates of subsequent morbid events. In multivariate analyses, only LV mass index at follow-up consistently predicted adverse outcomes.
The LV mass reduction during antihypertensive treatment is associated with reduced rate of complications of essential hypertension. Our data further suggest that development or regression of LV hypertrophy during antihypertensive treatment may be more closely linked to prognosis than are changes in clinic blood pressure.
抗高血压治疗期间左心室（LV）质量的降低是否能预测高血压心血管并发症的减少尚不确定。
共有172例前瞻性确定的原发性高血压患者，基线时无高血压并发症，相隔5.5±3.0年进行随访超声心动图检查，随后又随访4.8±2.9年。抗高血压治疗由主治医师决定。
在第二次超声心动图检查后，24例患者（14%）发生心血管事件。左心室质量未改变或降低的91例患者发生心血管事件的人数少于随访期间左心室质量增加的81例患者（8.8%[95%置信区间（CI）：3.9%-13.7%]对19.8%[95%CI 12.6%-27.0%]；P = 0.04），尽管前一组的基线左心室质量更大（118 g/m²[95%CI 111-125]对95 g/m²[95%CI 88-102]；P < 0.0001）。随访超声心动图上有无左心室肥厚是随后较低（9.2%[95%CI 5%-13.4%]）与较高（28.6%[95%CI 17.1%-40.1%]；P = 0.004）发病率的最强预测因素。在多变量分析中，只有随访时的左心室质量指数始终能预测不良结局。
抗高血压治疗期间左心室质量的降低与原发性高血压并发症发生率的降低有关。我们的数据进一步表明，抗高血压治疗期间左心室肥厚的发生或消退可能比临床血压变化与预后的联系更紧密。
