初始血压正常个体的左心室质量与高血压发病：强心研究
Left ventricular mass and incident hypertension in individuals with initial optimal blood pressure: the Strong Heart Study.
作者信息
de Simone Giovanni, Devereux Richard B, Chinali Marcello, Roman Mary J, Welty Thomas K, Lee Elisa T, Howard Barbara V
机构信息
Weill-Cornell Medical College, New York, NY, USA.
出版信息
J Hypertens. 2008 Sep;26(9):1868-74. doi: 10.1097/HJH.0b013e3283050899.
OBJECTIVE
Metabolic abnormalities have been shown to predict 8-year incident arterial hypertension in individuals with optimal blood pressure. As echocardiographic left ventricular mass has also been reported to predict incident hypertension in individuals with baseline blood pressure of less than 140/90 mmHg, we determined whether left ventricular mass predicts 4-year incident hypertension also in individuals with initial optimal blood pressure (<120/80 mmHg), independent of metabolic factors influencing blood pressure.
METHODS
We studied 777 of 3257 members of the American Indian population-based Strong Heart Study cohort with optimal blood pressure (34% men, 45% obese, and 35% diabetic), aged 57 +/- 7 years, and without prevalent cardiovascular disease.
RESULTS
Over 4 years, 159 individuals (20%, group H) developed hypertension (blood pressure >/=140/90 mmHg). They had a greater baseline BMI, waist girth, and blood pressure (112/69 vs. 109/68 mmHg, all P < 0.03) than those remaining normotensive (group N), with similar lipid profile and renal function. At baseline, left ventricular mass was significantly greater in group H than in group N (P < 0.004). The difference in left ventricular mass was confirmed after controlling for initial BMI, systolic blood pressure, homeostatic model assessment index, and diabetes. The probability of incident hypertension increased by 36% for each standard deviation of left ventricular mass index (P = 0.006), independent of covariates. Participants with left ventricular mass of more than 159 g (75th percentile of distribution) had 2.5-fold (95% confidence interval, 1.4-3.6; P < 0.001) higher adjusted risk of incident hypertension than those below this value.
CONCLUSION
Left ventricular mass predicts incident arterial hypertension in individuals with initially optimal blood pressure. This association is independent of body build, prevalent diabetes, and initial blood pressure.
目的
代谢异常已被证明可预测血压正常个体8年后发生动脉高血压的情况。由于据报道，超声心动图测量的左心室质量也可预测基线血压低于140/90 mmHg的个体发生高血压的情况，因此我们确定左心室质量是否也能预测初始血压正常（<120/80 mmHg）的个体4年后发生高血压的情况，且不受影响血压的代谢因素的影响。
方法
我们对基于美国印第安人群的强心脏研究队列中的3257名成员中的777名血压正常者进行了研究（男性占34%，肥胖者占45%，糖尿病患者占35%），年龄为57±7岁，且无心血管疾病史。
结果
在4年时间里，159名个体（20%，H组）患上了高血压（血压≥140/90 mmHg）。与仍保持血压正常的个体（N组）相比，他们的基线体重指数、腰围和血压更高（分别为112/69 mmHg和109/68 mmHg，P均<0.03），血脂谱和肾功能相似。基线时，H组的左心室质量显著高于N组（P<0.004）。在控制了初始体重指数、收缩压、稳态模型评估指数和糖尿病因素后，左心室质量的差异仍然存在。左心室质量指数每增加一个标准差，发生高血压的概率增加36%（P=0.006），且不受协变量的影响。左心室质量超过159 g（分布的第75百分位数）的参与者发生高血压的校正风险比低于此值的参与者高2.5倍（95%置信区间，1.4 - 3.6；P<0.001）。
结论
左心室质量可预测初始血压正常的个体发生动脉高血压的情况。这种关联独立于体型、糖尿病史和初始血压。
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