Milan Alberto, Caserta Mimma A, Del Colle Sara, Dematteis Antonio, Morello Fulvio, Rabbia Franco, Mulatero Paolo, Pandian Natesa G, Veglio Franco
Department of Medicine and Experimental Oncology, Hypertension Unit, University of Torino, Turin, Italy.
J Hypertens. 2007 Aug;25(8):1655-64. doi: 10.1097/HJH.0b013e3281ddb0a0.
Arterial hypertension is a common cause of cardiac organ damage, inducing morphological and functional modifications. Spontaneous baroreflex sensitivity (BRS) control of the heart rate is a key mechanism of blood pressure homeostasis, and is impaired in patients with hypertension. This study sought to assess the association between BRS and left ventricular morphology and function.
We studied 224 hypertensive patients (125 men; aged 47.8 +/- 10.8 years, mean +/- SD) compared with 51 normotensive control subjects (25 men, aged 45.7 +/- 12.5 years). Left ventricular morphology, systolic and diastolic function were evaluated by echocardiography. Spontaneous BRS was measured using the sequence method.
BRS was inversely associated with relative wall thickness (R = 0.17; P < 0.0001) and left ventricular mass index (R = 0.03; P = 0.01); in particular, BRS was significantly impaired in patients with concentric left ventricular remodelling (median [interquartile difference] 9.4 [4.1]) and hypertrophy (9.05 [3.9]) compared with the normal left ventricle (12.3 [5]; P < 0.001). BRS showed a significant association with systolic function evaluated by midwall fractional shortening (r = 0.28; P < 0.001), stroke volume (r = 0.27; P < 0.001), stroke work (r = 0.17; P < 0.05), and fractional shortening (r = 0.17; P < 0.05). BRS was significantly decreased in patients with diastolic dysfunction; it was lower in patients with diastolic dysfunction compared with both the control group and hypertensive patients with normal diastolic function.
BRS is associated with left ventricular morphology, systolic and diastolic function in hypertensive patients. In particular BRS is impaired in patients with diastolic dysfunction. These findings suggest a role for BRS as a target in arterial hypertension.
动脉高血压是心脏器官损害的常见原因，可引起形态和功能改变。心率的自发性压力反射敏感性（BRS）控制是血压稳态的关键机制，在高血压患者中受损。本研究旨在评估BRS与左心室形态和功能之间的关联。
我们研究了224例高血压患者（125例男性；年龄47.8±10.8岁，均值±标准差），并与51例血压正常的对照者（25例男性，年龄45.7±12.5岁）进行比较。通过超声心动图评估左心室形态、收缩和舒张功能。使用序列法测量自发性BRS。
BRS与相对室壁厚度（R = 0.17；P < 0.0001）和左心室质量指数（R = 0.03；P = 0.01）呈负相关；特别是，与正常左心室相比，同心性左心室重构（中位数[四分位间距]9.4[4.1]）和肥厚（9.05[3.9]）患者的BRS明显受损（12.3[5]；P < 0.001）。BRS与通过室壁中层缩短分数评估的收缩功能（r = 0.28；P < 0.001）、每搏输出量（r = 0.27；P < 0.001）、每搏功（r = 0.17；P < 0.05）和缩短分数（r = 0.17；P < 0.05）显著相关。舒张功能不全患者的BRS显著降低；与对照组和舒张功能正常的高血压患者相比，舒张功能不全患者的BRS更低。
BRS与高血压患者的左心室形态、收缩和舒张功能相关。特别是舒张功能不全患者的BRS受损。这些发现提示BRS可作为动脉高血压的一个治疗靶点。
