Salles Gil F, Fiszman Roberto, Cardoso Claudia R L, Muxfeldt Elizabeth S
University Hospital Clementino Fraga Filho, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Hypertension. 2007 Oct;50(4):723-8. doi: 10.1161/HYPERTENSIONAHA.107.093120. Epub 2007 Jul 16.
The relation between left ventricular hypertrophy (LVH) and unfavorable cardiovascular prognosis may involve systemic inflammation and endothelial dysfunction/damage. The aim of this study was to investigate in a cross-sectional design the relationships of LVH with C-reactive protein (CRP) levels (a marker of systemic low-grade inflammation) and with microalbuminuria (a marker of glomerular endothelial damage) in 705 patients with resistant hypertension. At baseline, all were submitted to a laboratory evaluation including 24-hour urinary albumin excretion, 2D echocardiogram, and 24-hour ambulatory blood pressure monitoring. A total of 463 patients also had high-sensitivity CRP levels determined. LVH was defined as an indexed left ventricular mass >110 g/m(2) in women and >125 g/m(2) in men. Microalbuminuria was evaluated in 3 categories: low normal (<15 mg/24 hours), high normal (between 15 and 29 mg/24 hours), and abnormal (between 30 and 299 mg/24 hours). CRP was dichotomized at the median value (3.7 mg/L). Associations with LVH were examined after adjustment for all of the potential confounders by multivariate logistic regression. A total of 534 patients (75.7%) had LVH. After full adjustment, both abnormal microalbuminuria (odds ratio: 1.97; 95% CI: 1.04 to 3.73) and high CRP (OR: 1.76; 95% CI: 1.06 to 2.93) were independently associated with LVH occurrence. The high-normal albuminuria was associated with a borderline significant 46% increased chance of having LVH. Furthermore, the association between high CRP and LVH was observed exclusively in the subgroup with normal albuminuria. In conclusion, both systemic inflammation and endothelial damage were associated with LVH occurrence. These relationships offer insight into the pathophysiological mechanisms linking LVH to atherosclerosis and to increased cardiovascular morbidity and mortality.
左心室肥厚（LVH）与不良心血管预后之间的关系可能涉及全身炎症以及内皮功能障碍/损伤。本研究的目的是采用横断面设计，调查705例顽固性高血压患者中LVH与C反应蛋白（CRP）水平（全身低度炎症的标志物）以及微量白蛋白尿（肾小球内皮损伤的标志物）之间的关系。在基线时，所有患者均接受实验室评估，包括24小时尿白蛋白排泄、二维超声心动图和24小时动态血压监测。共有463例患者还测定了高敏CRP水平。LVH的定义为女性左心室质量指数>110 g/m²，男性>125 g/m²。微量白蛋白尿分为3类进行评估：低正常水平（<15 mg/24小时）、高正常水平（15至29 mg/24小时之间）和异常水平（30至299 mg/24小时之间）。CRP以中位数（3.7 mg/L）进行二分法划分。通过多因素逻辑回归对所有潜在混杂因素进行校正后，检查与LVH的关联。共有534例患者（75.7%）有LVH。经过全面校正后，异常微量白蛋白尿（比值比：1.97；95%可信区间：1.04至3.73）和高CRP（比值比：1.76；95%可信区间：1.06至2.93）均与LVH的发生独立相关。高正常水平白蛋白尿与LVH发生几率增加46%存在临界显著关联。此外，高CRP与LVH之间的关联仅在白蛋白尿正常的亚组中观察到。总之，全身炎症和内皮损伤均与LVH的发生有关。这些关系为将LVH与动脉粥样硬化以及心血管发病率和死亡率增加联系起来的病理生理机制提供了见解。
