Department of Integrated Medicine, Kagawa University, Kagawa, Japan.
Clin Exp Hypertens. 2012;34(3):176-81. doi: 10.3109/10641963.2011.577490. Epub 2011 Oct 3.
Left ventricular (LV) hypertrophy and diastolic dysfunction are commonly observed in hypertensive patients, and have been demonstrated to be risk factors of chronic heart failure due to LV diastolic dysfunction. Recently, reduced bone mineral density has been found in hypertensive patients compared with healthy controls. However, relationships between bone mineral density and LV hypertrophy and diastolic dysfunction have not been fully assessed. We examined relationships between bone mineral density and both LV hypertrophy and diastolic dysfunction in 38 hypertensive patients (23 males, 15 females; mean age 71 ± 8 y) who had been treated with antihypertensive drugs for at least 1 year. The bone mineral density of the calcaneus was measured with a quantitative ultrasound measurement device (A-1000 EXPRESS/InSight, GE Healthcare, Horten, Norway), and the stiffness index was determined as a parameter of bone mineral density. Echocardiography was performed to measure the left ventricular mass index as a parameter of LV hypertrophy. Left ventricular diastolic dysfunction was also assessed by early diastolic mitral annular velocity (e'), and the ratio of early transmitral flow velocity (E) to e' (E/e'). The bone mineral density did not correlate with left ventricular mass index, but did correlate with e' (r = 0.453, P < .01) and E/e' (r = -0.359, P < .05). Thus, reduced bone mineral density in hypertensive patients is not associated with LV hypertrophy but with LV diastolic dysfunction. Hypertensive patients with reduced bone mineral density may have a high risk of chronic heart failure due to LV diastolic dysfunction as well as bone fractures due to osteoporosis.
左心室（LV）肥大和舒张功能障碍在高血压患者中很常见，并且已被证明是由于 LV 舒张功能障碍导致慢性心力衰竭的危险因素。最近，与健康对照组相比，高血压患者的骨密度降低。然而，骨密度与 LV 肥大和舒张功能障碍之间的关系尚未得到充分评估。我们检查了 38 名接受降压药物治疗至少 1 年的高血压患者（23 名男性，15 名女性；平均年龄 71±8 岁）的骨密度与 LV 肥大和舒张功能障碍之间的关系。用定量超声测量装置（A-1000 EXPRESS/InSight，GE Healthcare，Horten，挪威）测量跟骨的骨密度，并将刚度指数确定为骨密度的参数。通过超声心动图测量左心室质量指数作为 LV 肥大的参数。还通过早期舒张二尖瓣环速度（e'）评估左心室舒张功能障碍，并通过早期二尖瓣血流速度（E）与 e'的比值（E/e'）评估。骨密度与左心室质量指数不相关，但与 e'（r = 0.453，P <.01）和 E/e'（r = -0.359，P <.05）相关。因此，高血压患者的骨密度降低与 LV 肥大无关，但与 LV 舒张功能障碍有关。骨密度降低的高血压患者可能由于 LV 舒张功能障碍以及骨质疏松引起的骨折而患有慢性心力衰竭的高风险。
