醛固酮与高血压患者左心室质量的关系：与血浆纤维蛋白原水平的相互作用。

Association of aldosterone with left ventricular mass in hypertension: interaction with plasma fibrinogen levels.

机构信息

Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medicine, University of Udine, Italy.

出版信息

Am J Hypertens. 2013 Jan;26(1):111-7. doi: 10.1093/ajh/hps006. Epub 2012 Dec 13.

DOI:10.1093/ajh/hps006

PMID:23382334

Abstract

BACKGROUND

Plasma aldosterone concentration is an independent determinant of left ventricular (LV) mass in hypertensive patients, and is related to some hemostatic variables along with it may contribute to a prothrombotic state. We conducted a study to investigate the relationship between hemostatic variables, plasma aldosterone, and cardiac morphology and function in essential hypertension.

METHODS

In 205 patients with untreated essential hypertension, we measured components of the renin-angiotensin-aldosterone system, plasma levels of fibrinogen, D-dimer, prothrombin fragment 1 + 2 (F1 + 2), and plasminogen activator inhibitor-1 (PAI-1), and assessed cardiac characteristics with standard echocardiography. For statistical purpose, patients were divided into two groups according to whether their median value of plasma aldosterone was > 125 pg/ml or < 125 pg/ml.

RESULTS

Left ventricular mass index (LVMI) was significantly greater in patients with a high (> 51 ± 13 g/m(2.7)) than with a low plasma aldosterone level (< 41 ± 11 g/m(2.7); P < 0.01) only in patients with fibrinogen levels in the highest tertile. Significant interaction was observed between plasma fibrinogen and aldosterone in the association with LVMI (P = 0.04). Left ventricular mass index was significantly and directly related to age, systolic blood pressure (BP), body mass index (BMI), plasma aldosterone, fibrinogen, and D-dimer levels, whereas no relationships were observed between echocardiographic parameters and other hemostatic variables. Fibrinogen was directly related to age, systolic BP, plasma aldosterone, LVMI, relative wall thickness, and left atrial diameter. Multivariate analysis indicated that LVMI was related to plasma fibrinogen and aldosterone (both P < 0.01) independently of age, BP, and BMI.

CONCLUSIONS

Plasma fibrinogen levels interact with plasma aldosterone in its association with left ventricular mass in patients with hypertension.

摘要

背景

在高血压患者中，血浆醛固酮浓度是左心室（LV）质量的独立决定因素，并且与一些止血变量相关，这些变量可能导致血栓形成状态。我们进行了一项研究，以调查原发性高血压患者中止血变量、血浆醛固酮与心脏形态和功能之间的关系。

方法

在 205 名未经治疗的原发性高血压患者中，我们测量了肾素-血管紧张素-醛固酮系统的组成部分、血浆纤维蛋白原、D-二聚体、凝血酶原片段 1 + 2（F1 + 2）和纤溶酶原激活物抑制剂-1（PAI-1）的水平，并使用标准超声心动图评估心脏特征。出于统计目的，根据患者的血浆醛固酮中位数是否大于 125pg/ml（>125pg/ml）或小于 125pg/ml（<125pg/ml）将其分为两组。

结果

只有在纤维蛋白原水平处于最高三分位的患者中，高（>51 ± 13g/m2.7）而非低（<41 ± 11g/m2.7）血浆醛固酮水平的患者左心室质量指数（LVMI）显著更大（P<0.01）。观察到血浆纤维蛋白原和醛固酮与 LVMI 之间的关联存在显著的交互作用（P=0.04）。左心室质量指数与年龄、收缩压（BP）、体重指数（BMI）、血浆醛固酮、纤维蛋白原和 D-二聚体水平显著直接相关，而超声心动图参数与其他止血变量之间无相关性。纤维蛋白原与年龄、收缩压、血浆醛固酮、LVMI、相对壁厚度和左心房直径直接相关。多变量分析表明，LVMI 与血浆纤维蛋白原和醛固酮均相关（均 P<0.01），独立于年龄、BP 和 BMI。