Cuspidi Cesare, Giudici Valentina, Lonati Laura, Sala Carla, Valerio Cristiana, Mancia Giuseppe
Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milano, Italy.
Blood Press. 2010 Dec;19(6):337-43. doi: 10.3109/08037051.2010.506029. Epub 2010 Jul 20.
Weight and height are two major determinants of left ventricular mass (LVM); the anthropometric parameter to which LVM should be normalized remains, however, debated. In a population of hypertensives, we compared the prevalence of left ventricular hypertrophy (LVH) defined by two indexation criteria of LVM in different subgroups of body mass index (BMI).
A total of 4468 essential hypertensives included in the Evaluation of Target Organ Damage in Hypertension (ETODH), were divided in four groups according to BMI thresholds: lean (BMI<20 kg/m(2), 4.5%), normal (20-24.9 kg/m(2), 36.5%), overweight (25-29.9 kg/m(2), 41.9%) and obese (≥ 30 kg/m(2), 17.1%). All patients underwent quantitative echocardiography; LVH was defined by two criteria of LVM indexation: (A) ≥ 116 g/m(2) in men and ≥ 96 g/m(2) in women; (B) ≥ 49 g/m(2.7) in men and ≥ 45 g/m(2.7) in women.
Overall, 44.9% of the patients were found to have LVH by criterion A, 48.2% by criterion B and 37.0% by both criteria. Prevalence rates of LVH in the four BMI groups were 34.3%, 40.5%, 47.3%, 53.9% by criterion A, 19.8%, 37.0%, 53.6%, 69.7% by criterion B, and 14.2%, 30.9%, 41.5%, 47.8% by both criteria, respectively (p at least <0.05 for all).
Our findings show that LVH prevalence in both overweight and obese hypertensives is higher when LVM is normalized to height(2.7) compared with body surface area (BSA), whereas the opposite trend occurs in normal weight/lean hypertensives. Thus, the risk related to LVH is underestimated when the LVH/height(2.7) criterion is applied to lean/normal weight individuals and the LVH/BSA criterion in overweight/obese individuals.
体重和身高是左心室质量（LVM）的两个主要决定因素；然而，LVM应标准化的人体测量参数仍存在争议。在一组高血压患者中，我们比较了在不同体重指数（BMI）亚组中由两种LVM指数标准定义的左心室肥厚（LVH）的患病率。
共有4468名纳入高血压靶器官损害评估（ETODH）的原发性高血压患者，根据BMI阈值分为四组：消瘦（BMI<20kg/m²，4.5%）、正常（20 - 24.9kg/m²，36.5%）、超重（25 - 29.9kg/m²，41.9%）和肥胖（≥30kg/m²，17.1%）。所有患者均接受定量超声心动图检查；LVH由两种LVM指数标准定义：（A）男性≥116g/m²，女性≥96g/m²；（B）男性≥49g/m².⁷，女性≥45g/m².⁷。
总体而言，根据标准A，44.9%的患者被发现有LVH；根据标准B，48.2%的患者有LVH；两种标准均符合的患者为37.0%。四个BMI组中LVH的患病率，根据标准A分别为34.3%、40.5%、47.3%、53.9%；根据标准B分别为19.8%、37.0%、53.6%、69.7%；两种标准均符合的分别为14.2%、30.9%、41.5%、47.8%（所有p值至少<0.05）。
我们的研究结果表明，与体表面积（BSA）相比，当LVM按身高².⁷标准化时，超重和肥胖高血压患者中LVH的患病率更高，而在正常体重/消瘦高血压患者中则出现相反趋势。因此，当将LVH/身高².⁷标准应用于消瘦/正常体重个体，以及将LVH/BSA标准应用于超重/肥胖个体时，与LVH相关的风险被低估。
