González Maqueda I
Rev Esp Cardiol. 1991 Nov;44(9):586-98.
Arterial hypertension is the most common cause of chronic pressure overload of the left ventricle. Electrocardiographic and echocardiographic signs of left ventricular hypertrophy in hypertensive patients are associated with an increased cardiovascular mortality and incidence of sudden death habitually due to ventricular arrhythmias. The significance of a normal increase in systolic blood pressure during exercise in persons without evident resting hypertension is uncertain. M-mode and 2D echocardiography, 24-hour continuous ambulatory electrocardiographic (Holter), exercise testing and 24-hour ambulatory blood pressure monitoring (ABPM) were performed on 22 normotensive patients (group I); 25 normotensives with exaggerated blood pressure response to exercise (greater than 220 mmHg) (group II) and 33 hypertensive patients (group III). None was taking cardioactive drugs. Left ventricular hypertrophy (LVH) was found on one patient of group I (4.5%), 13 of group II (52%) and 20 of group III (61%). Left ventricular mass index (LVMI) was linearly correlated with maximum exercise blood pressure (group I: r2 = 0.518, p less than 0.0002; group II: r2 = 0.098, NS; group III: r2 = 0.407, p less than 0.0001) with 24-hour systolic pressure overload (ABPM) (group I: r2 = 0.848, p less than 0.0001; group II: r2 = 0.705, p less than 0.0001; group III: r2 = 0.839, p less than 0.0001) and 24-hour diastolic pressure overload (ABPM) (group I: r2 = 0.612, p less than 0.0001; group II: r2 = 0.815, p less than 0.0001; group III: r2 = 0.807, p less than 0.0001) within each group but not between different groups. The hypertensive subjects (group III) had a higher average heart rate (p less than 0.0001) more supraventricular premature (p less than 0.0001) and ventricular premature (p less than 0.0001) beats than the normotensive (group I) and normotensive patients with abnormal increases in systolic blood pressure response to exercise (group II) (p less than 0.0001) (NS) and (p less than 0.0002), respectively. LVMI was linearly correlated with ventricular premature beats (group I: r2 = 0.072, NS; group II: r2 = 0.823, p less than 0.0001; group III: r2 = 0.691, p less than 0.0001). Frequent and complex ventricular arrhythmias were more common in patients with LVH normotensives or hypertensives than without LVI (p less than 0.0001) and the age increases their severity. We conclude that normotensives with hypertensive response to exercise have similar incidence of LVI; if those patients develop sustained hypertension, LVI was previous to arterial hypertension. There are two types of hypertrophy: secondary hypertrophy is linked to the high afterload and vasoconstriction typical in hypertension.(ABSTRACT TRUNCATED AT 400 WORDS)
动脉高血压是左心室慢性压力负荷过重最常见的原因。高血压患者左心室肥厚的心电图和超声心动图表现与心血管死亡率增加以及通常因室性心律失常导致的猝死发生率增加相关。在无明显静息高血压的人群中，运动期间收缩压正常升高的意义尚不确定。对22名血压正常的患者（I组）、25名运动后血压反应过度（大于220 mmHg）的血压正常者（II组）和33名高血压患者（III组）进行了M型和二维超声心动图、24小时动态心电图（Holter）、运动试验以及24小时动态血压监测（ABPM）。所有患者均未服用心血管活性药物。I组有1名患者（4.5%）发现左心室肥厚（LVH），II组有13名（52%），III组有20名（61%）。左心室质量指数（LVMI）与最大运动血压呈线性相关（I组：r2 = 0.518，p < 0.0002；II组：r2 = 0.098，无统计学意义；III组：r2 = 0.407，p < 0.0001），与24小时收缩压负荷（ABPM）（I组：r2 = 0.848，p < 0.0001；II组：r2 = 0.705，p < 0.0001；III组：r2 = 0.839，p < 0.0001）以及24小时舒张压负荷（ABPM）（I组：r2 = 0.612，p < 0.0001；II组：r2 = 0.815，p < 0.0001；III组：r2 = 0.807，p < 0.0001）在每组内相关，但不同组之间无相关性。高血压患者（III组）的平均心率较高（p < 0.0001），室上性早搏（p < 0.0001）和室性早搏（p < 0.0001）比血压正常者（I组）以及运动后收缩压反应异常增加的血压正常患者（II组）更常见（分别为p < 0.0001、无统计学意义和p < 0.0002）。LVMI与室性早搏呈线性相关（I组：r2 = 0.072，无统计学意义；II组：r2 = 0.823，p < 0.0001；III组：r2 = 0.691，p < 0.0001）。LVH的血压正常者或高血压患者中，频发和复杂的室性心律失常比无LVH者更常见（p < 0.0001），且年龄会加重其严重程度。我们得出结论，运动后有高血压反应的血压正常者LVH的发生率相似；如果这些患者发展为持续性高血压，LVH先于动脉高血压出现。有两种类型的肥厚：继发性肥厚与高血压典型的高后负荷和血管收缩有关。（摘要截取自400字）
