Cuspidi Cesare, Meani Stefano, Valerio Cristiana, Fusi Veronica, Sala Carla, Maisaidi Meilikemu, Zanchetti Alberto
Istituto di Medicina Cardiovascolare, Università di Milano, Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Ospedale Maggiore Policlinico IRCCS, Italy.
Blood Press. 2006;15(2):107-15. doi: 10.1080/08037050600593052.
The 2003 European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines recommend angiotensin II receptor antagonists (AIIRAs) as a first-line therapy in hypertensives with left ventricular hypertrophy (LVH).
We investigated the long-term effects of an AIIRA-based therapy on left ventricular (LV) structure and geometry in previously, unsatisfactorily treated essential hypertensive patients.
Sixty-eight consecutive patients referred to our hypertension hospital outpatient clinic with: (i) LVH (LV mass index, LVMI 51 g/m(2.7) in men and 47 g/m(2.7) in women), (ii) uncontrolled clinic blood pressure (BP140 and/or 90 mmHg) and (iii) antihypertensive therapy not including angiotensin-converting enzyme (ACE) inhibitors or AIIRAs were selected for this study. Two-dimensionally guided M-mode echocardiograms were carried out at baseline and after 6, 12, 18 and 24 months of follow-up. In all patients, losartan (50-100 mg/day, mean dose 82 mg/day) was added as first step to the previous therapy. Additional drugs, tailored to the single patient, were added, if necessary, to achieve target BP values (<140/90 mmHg).
Overall, 59 patients completed the study with the primary efficacy measurements (LVMI) at all appropriate times. A significant reduction in both clinic systolic BP and diastolic BP was found across the entire period of study respect to baseline (-17/10, -22/12, -24/13 and -26/14 mmHg at 6, 12, 18 and 24 months, p < 0.001 respectively), leading to target clinic BP in 75.6% of cases. LVMI was significantly lower after 1 year of treatment (-11 +/- 12%, p < 0.05) with a further significant reduction at the end of treatment (-22 +/- 18%, p < 0.01). The proportion of patients achieving normalization of LVMI was 47.4% and more importantly, the prevalence of concentric LVH fell from 38.9% to 6.7% (p < 0.01).
Our findings indicate that long-term intensive treatment based on the AIIRA losartan induced a normalization of LVH in about 50% of patients and more importantly caused an almost complete regression of concentric LVH, the most dangerous adaptive pattern. The transition from concentric to normal or eccentric LV geometry may have in these high-risk patients a favourable prognostic implication in addition to the recognized positive effect of reducing LVMI.
2003年欧洲高血压学会/欧洲心脏病学会（ESH/ESC）指南推荐血管紧张素II受体拮抗剂（AIIRAs）作为左心室肥厚（LVH）高血压患者的一线治疗药物。
我们研究了以AIIRA为基础的治疗对既往治疗效果不佳的原发性高血压患者左心室（LV）结构和几何形态的长期影响。
连续68例转诊至我院高血压门诊的患者入选本研究，入选标准为：（i）LVH（男性左心室质量指数，LVMI≥51 g/m².⁷，女性≥47 g/m².⁷），（ii）诊室血压未得到控制（收缩压≥140和/或舒张压≥90 mmHg），（iii）抗高血压治疗未包括血管紧张素转换酶（ACE）抑制剂或AIIRAs。在基线时以及随访6、12、18和24个月后进行二维引导的M型超声心动图检查。在所有患者中，第一步是在先前治疗基础上加用氯沙坦（50 - 100 mg/天，平均剂量82 mg/天）。如有必要，根据个体患者情况加用其他药物，以达到目标血压值（<140/90 mmHg）。
总体而言，59例患者在所有合适时间完成了主要疗效指标（LVMI）的研究。在整个研究期间，与基线相比，诊室收缩压和舒张压均显著降低（6、12个月时分别为-17/10 mmHg、-22/12 mmHg，18、24个月时分别为-24/13 mmHg、-26/14 mmHg，p均<0.001），75.6%的病例达到了目标诊室血压。治疗1年后LVMI显著降低（-11±12%，p<0.05），治疗结束时进一步显著降低（-22±18%，p<0.01）。LVMI恢复正常的患者比例为47.4%，更重要的是，向心性LVH的患病率从38.9%降至6.7%（p<0.01）。
我们的研究结果表明，基于AIIRA氯沙坦的长期强化治疗使约50%的患者LVH恢复正常，更重要的是导致了最危险的适应性模式——向心性LVH几乎完全消退。在这些高危患者中，从向心性LV几何形态转变为正常或离心性LV几何形态，除了降低LVMI的公认积极作用外，可能还具有有利的预后意义。
