Hashimoto Junichiro, Westerhof Berend E, Westerhof Nico, Imai Yutaka, O'Rourke Michael F
Department of Planning for Drug Development and Clinical Evaluation, Tohoku University, Japan.
J Hypertens. 2008 May;26(5):1017-24. doi: 10.1097/HJH.0b013e3282f62a9b.
Regression of left ventricular (LV) mass during antihypertensive treatment has been associated with reduction in aortic augmentation index, a composite measure of peripheral wave reflection. The aim of this study was to clarify which of the two reflection factors, that is magnitude or timing, plays the dominant role in this regression.
We evaluated the reflection magnitude (RM; the reflected-to-forward pressure wave amplitude ratio), the round-trip travel time of the pressure wave (a parameter for reflection timing), and the aortic pulse wave velocity (PWV) with echocardiographic LV mass in 61 hypertensive patients before and after 1-year standard medical treatment.
Antihypertensive therapy significantly (P < 0.01) decreased brachial and aortic blood pressures and aortic PWV, reduced LV mass, and increased travel time. Neither increase in travel time nor decrease in PWV, however, was related to the reduction in LV mass. By contrast, treatment-induced change in RM was significantly correlated with change in LV mass; the correlation was particularly close in patients with LV hypertrophy (r = 0.61, P < 0.001). Only a marginal correlation was observed between the changes in RM and travel time. The association between RM decrease and LV mass reduction was independent of age, sex, changes in travel time and blood pressure, and use of renin-angiotensin system inhibitors (beta = 0.41, P = 0.001).
Decreased wave RM contributes to LV mass regression more strongly than, and independently of, delayed reflection timing. Peripheral muscular arteries (from which reflection arises) appear to be more important therapeutic targets in regressing LV mass than central elastic arteries.
降压治疗期间左心室（LV）质量的消退与主动脉增强指数的降低有关，主动脉增强指数是外周波反射的综合指标。本研究的目的是明确两个反射因素中的哪一个，即幅度或时间，在这种消退中起主导作用。
我们在61例高血压患者接受1年标准药物治疗前后，用超声心动图评估了反射幅度（RM；反射压力波与正向压力波振幅比）、压力波的往返传播时间（反射时间的一个参数）以及主动脉脉搏波速度（PWV）与LV质量的关系。
降压治疗显著（P<0.01）降低了肱动脉和主动脉血压以及主动脉PWV，减轻了LV质量，并增加了传播时间。然而，传播时间的增加和PWV的降低均与LV质量的减轻无关。相比之下，治疗引起的RM变化与LV质量变化显著相关；在LV肥厚患者中这种相关性尤为密切（r = 0.61，P<0.001）。RM变化与传播时间变化之间仅观察到微弱的相关性。RM降低与LV质量减轻之间的关联独立于年龄、性别、传播时间和血压的变化以及肾素-血管紧张素系统抑制剂的使用（β = 0.41，P = 0.001）。
波RM降低对LV质量消退的贡献比反射时间延迟更强烈且更独立。外周肌性动脉（反射产生于此）似乎比中央弹性动脉在LV质量消退方面是更重要的治疗靶点。
