Viazzi Francesca, Leoncini Giovanna, Ratto Elena, Parodi Angelica, Falqui Valeria, Conti Novella, Tomolillo Cinzia, Ravera Giambattista, Deferrari Giacomo, Pontremoli Roberto
Department of Internal Medicine and Cardionephrology, Azienda Universitaria Ospedale San Martino, Genoa, Italy.
Hypertens Res. 2008 May;31(5):873-9. doi: 10.1291/hypres.31.873.
Sub-clinical organ damage is a strong independent predictor of cardiovascular mortality in primary hypertension, and its changes over time parallel those in risk of cardiovascular events. A better understanding of the pathogenetic mechanisms underlying the development of target organ damage may help us devise more effective therapeutic strategies. We therefore investigated the relationship between the presence of organ damage and some of its potential determinants, such as blood pressure severity and early atherosclerotic abnormalities. Thirty-seven untreated, non-diabetic hypertensive patients were enrolled. Target organ damage was assessed by albuminuria and left ventricular mass index; systemic vascular permeability was evaluated by transcapillary escape rate of albumin (TERalb); and blood pressure was measured by 24h ambulatory blood pressure monitoring. The albumin-to-creatinine ratio and left ventricular mass index were directly related to TERalb (r = 0.48, p = 0.003 and r = 0.39, p < 0.020, respectively) and 24-h systolic blood pressure values (r = 0.54, p < 0.001; r = 0.60, p < 0.001). The simultaneous occurrence of increased blood pressure load and TERalb was associated with higher left ventricular mass index values (p = 0.012) and entailed an increased risk of having at least one sign of damage (chi2 = 17.4; p < 0.001). Logistic regression analysis showed that the risk of presenting at least one sign of organ damage increased more than ten-fold when TERalb was above the median and more than five-fold with each 10 mmHg increase in 24-h systolic blood pressure. Blood pressure load and vascular permeability are potentially modifiable factors that are independently associated with the occurrence of sub-clinical signs of renal and cardiac damage in hypertensive patients.
亚临床器官损害是原发性高血压患者心血管死亡的一个强有力的独立预测因素，其随时间的变化与心血管事件风险的变化相似。更好地了解靶器官损害发生的致病机制可能有助于我们制定更有效的治疗策略。因此，我们研究了器官损害的存在与其一些潜在决定因素之间的关系，如血压严重程度和早期动脉粥样硬化异常。纳入了37例未经治疗的非糖尿病高血压患者。通过蛋白尿和左心室质量指数评估靶器官损害；通过白蛋白的跨毛细血管逃逸率（TERalb）评估全身血管通透性；通过24小时动态血压监测测量血压。白蛋白与肌酐比值和左心室质量指数分别与TERalb直接相关（r = 0.48，p = 0.003和r = 0.39，p < 0.020）以及24小时收缩压值相关（r = 0.54，p < 0.001；r = 0.60，p < 0.001）。血压负荷增加和TERalb同时出现与更高的左心室质量指数值相关（p = 0.012），并且至少有一项损害迹象的风险增加（χ2 = 17.4；p < 0.001）。逻辑回归分析显示，当TERalb高于中位数时，出现至少一项器官损害迹象的风险增加超过10倍，24小时收缩压每升高10 mmHg，风险增加超过5倍。血压负荷和血管通透性是潜在可改变的因素，它们与高血压患者肾脏和心脏损害的亚临床迹象的发生独立相关。
