Rubattu Speranza, Sciarretta Sebastiano, Ciavarella Giuseppino Massimo, Venturelli Vanessa, De Paolis Paola, Tocci Giuliano, De Biase Luciano, Ferrucci Andrea, Volpe Massimo
U.O. Cardiologia, IInd School of Medicine, University of Rome La Sapienza, S. Andrea Hospital, Rome, Italy.
J Hypertens. 2007 Apr;25(4):833-9. doi: 10.1097/HJH.0b013e32803cae3c.
The metabolic syndrome (MS) is associated with left ventricular hypertrophy (LVH). Previous evidence has shown that LVH is favoured by low levels of atrial natriuretic peptide (ANP), independently from blood pressure (BP), in hypertension. Although levels of natriuretic peptides are known to be lower in obesity, plasma ANP levels have not yet been assessed in MS. We aimed to assess the ANP levels and their relationship with left ventricular mass (LVM) in patients affected by MS.
One hundred and twenty-eight essential hypertensive patients were included in the study: 51 with MS and 77 without MS. Clinical, echocardiographical and biochemical parameters, and levels of both N-terminal (NT)-proANP and alphaANP were assessed.
Hypertensive patients affected by MS had higher LVM and increased frequency of LVH. NT-proANP levels were significantly lower in MS, independent of waist circumference (WC). Log(NT-proANP) levels were significantly inversely related to left ventricular mass index (LVMI) (beta = -0.360, P < 0.001) and LVM/height (beta = -0.370, P < 0.001) in the whole hypertensive population by multiple linear regression analysis. The relationship of log(NT-proANP) with LVM was more enhanced in patients with MS.
The present study demonstrates that levels of NT-proANP are significantly reduced in hypertensive patients affected by MS, and they are significantly inversely related to the increased LVM observed in these patients. Our findings, while supporting previous experimental and clinical evidence of the antihypertrophic role of ANP in hypertension, may help to identify one of the possible mechanisms directly underlying LVH in MS.
代谢综合征（MS）与左心室肥厚（LVH）相关。既往证据表明，在高血压患者中，低水平的心房利钠肽（ANP）有利于左心室肥厚的发生，且独立于血压（BP）。尽管已知肥胖患者利钠肽水平较低，但尚未对MS患者的血浆ANP水平进行评估。我们旨在评估MS患者的ANP水平及其与左心室质量（LVM）的关系。
128例原发性高血压患者纳入本研究：51例患有MS，77例未患MS。评估临床、超声心动图和生化参数，以及N末端（NT）-proANP和αANP的水平。
患有MS的高血压患者左心室质量较高，左心室肥厚的发生率增加。MS患者的NT-proANP水平显著较低，与腰围（WC）无关。通过多元线性回归分析，在整个高血压人群中，Log（NT-proANP）水平与左心室质量指数（LVMI）（β = -0.360，P < 0.001）和LVM/身高（β = -0.370，P < 0.001）显著负相关。在MS患者中，Log（NT-proANP）与LVM的关系更为密切。
本研究表明，患有MS的高血压患者NT-proANP水平显著降低，且与这些患者中观察到的左心室质量增加显著负相关。我们的研究结果在支持既往关于ANP在高血压中抗肥厚作用的实验和临床证据的同时，可能有助于确定MS患者左心室肥厚直接潜在的可能机制之一。
