Grossman E, Messerli F H
Hypertension Unit, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
J Cardiovasc Pharmacol. 1992;20 Suppl 10:S1-6.
The major target organs that suffer from sustained hypertension are the heart, kidneys, and brain. Cardiac adaptation to arterial hypertension consists of left ventricular hypertrophy (LVH) of the concentric type, that is, an increase in wall thickness at the expense of chamber volume. However, LVH can no longer be considered a simple adaptive myocardial process serving to compensate for the increase in afterload and bring left ventricular wall stress back to normal. Data from the Framingham cohort have shown that the occurrence of LVH drastically increases the risk of sudden death and other cardiovascular morbidity and mortality irrespective of the levels of arterial pressure. Renal adaptation to arterial hypertension consists of a decrease in renal blood flow with elevations in filtration fraction and renal vascular resistance. With progressive hypertensive cardiovascular disease, glomerular filtration rate will fall as well. Recent data in patients with mild-to-moderate hypertension demonstrate that despite "efficacious" antihypertensive therapy, one-third to one-half of hypertensive patients may experience a significant decline in renal function. Cerebrovascular adaptation to hypertension consists of micro- and macrovascular disease leading to vascular dementia, or ischemic or hemorrhagic stroke. Cerebrovascular autoregulation, the mechanism by which cerebral blood flow is maintained, despite changes in arterial pressure, may be altered in hypertension.
持续高血压所累及的主要靶器官是心脏、肾脏和大脑。心脏对动脉高血压的适应性变化包括向心性左心室肥厚（LVH），即室壁厚度增加而腔室容积减小。然而，LVH不再被认为是一个单纯的适应性心肌过程，其作用是补偿后负荷增加并使左心室壁应力恢复正常。来自弗雷明汉姆队列研究的数据表明，无论动脉压水平如何，LVH的出现都会大幅增加猝死及其他心血管疾病发病和死亡的风险。肾脏对动脉高血压的适应性变化包括肾血流量减少，同时滤过分数和肾血管阻力升高。随着高血压性心血管疾病的进展，肾小球滤过率也会下降。近期针对轻至中度高血压患者的数据表明，尽管进行了“有效”的降压治疗，但仍有三分之一至二分之一的高血压患者可能出现肾功能显著下降。脑血管对高血压的适应性变化包括微血管和大血管病变，可导致血管性痴呆、缺血性或出血性卒中。脑血管自身调节是一种在动脉压变化时维持脑血流量的机制，在高血压时可能会发生改变。
