Hashimoto Junichiro, Imai Yutaka, O'Rourke Michael F
Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Science and Medicine, Aramaki, Sendai, Japan.
Am J Hypertens. 2007 Nov;20(11):1229-33. doi: 10.1016/j.amjhyper.2007.07.010.
Pressure pulse waveform features may predict treatment-induced regression of left ventricular (LV) mass better than casual brachial blood pressure (BP). We compared predictive power for LV mass reduction between the putative optimal pulse waveform feature (pulse amplification) and the putative optimal brachial cuff measurement (self BP monitoring at home).
Forty-three patients with hypertension received standard medical treatment for 1 year. Self BP monitoring was used to determine home morning and evening BPs. Radial pressure waveforms recorded with applanation tonometry in the clinic were transformed to aortic waveforms, and pulse amplification (upper limb pulse pressure/central pulse pressure) was calculated.
Antihypertensive therapy significantly (P < .05) reduced LV load, manifest by a decrease in both home BPs and by an increase in amplification. These changes were accompanied by significant reduction in echocardiographically determined LV mass index (LVMI). However, treatment-induced LVMI change did not correlate with change in any component of home BPs, but closely correlated with change in amplification (r = -0.54, P < .001). Amplification was a strong determinant of LVMI reduction, independent of age, gender, and home BP. Estimated subject numbers required for predicting a significant LVMI reduction were far less when the pulse waves were used rather than home BP; for alpha = 0.05 and beta = 0.20, numbers were 25 subjects for amplification but more than 1000 for home BP.
Regression of LV mass is closely associated with reduction in wave reflection, and can be assessed more precisely and easily from radial tonometry than use of the brachial cuff measurement, even in the home setting.
压力脉搏波形特征在预测治疗引起的左心室（LV）质量消退方面可能比偶然测量的肱动脉血压（BP）更好。我们比较了假定的最佳脉搏波形特征（脉搏放大）和假定的最佳肱动脉袖带测量值（在家自我血压监测）对左心室质量减轻的预测能力。
43例高血压患者接受标准药物治疗1年。使用自我血压监测来确定家中早晚血压。在诊所通过压平式眼压计记录的桡动脉压力波形被转换为主动脉波形，并计算脉搏放大率（上肢脉压/中心脉压）。
抗高血压治疗显著（P <.05）降低了左心室负荷，表现为家中血压均下降以及放大率增加。这些变化伴随着超声心动图测定的左心室质量指数（LVMI）显著降低。然而，治疗引起的LVMI变化与家中血压的任何组成部分的变化均无相关性，但与放大率变化密切相关（r = -0.54，P <.001）。放大率是LVMI降低的一个重要决定因素，独立于年龄、性别和家中血压。当使用脉搏波而不是家中血压来预测LVMI显著降低所需的估计受试者数量要少得多；对于α = 0.05和β = 0.20，放大率所需受试者数量为25名，但家中血压则超过1000名。
左心室质量消退与波反射减少密切相关，并且即使在家中环境下，通过桡动脉眼压测量法比使用肱动脉袖带测量能更精确、更容易地评估。
