Devereux R B, Pickering T G, Alderman M H, Chien S, Borer J S, Laragh J H
Hypertension. 1987 Feb;9(2 Pt 2):II53-60. doi: 10.1161/01.hyp.9.2_pt_2.ii53.
In less than a decade since development of echocardiographic measurement of left ventricular muscle mass, studies using this technique have provided considerable information about the prevalence and pathophysiology of left ventricular hypertrophy in human hypertension. Increased left ventricular mass has been found in a significant minority of patients with systemic hypertension, with the exact prevalence dependent both on how a population is selected and on the sex, race, and possibly age composition of its members. All published studies have reported that left ventricular hypertrophy is more closely related to blood pressure recorded in the patient's natural setting during normal activity or exercise-whether measured by portable recorder or home manometer-than to blood pressure measured by the physician. In addition, studies indicate that the classic hypertensive abnormalities of concentric left ventricular hypertrophy and increased peripheral resistance are interrelated, while left ventricular hypertrophy is absent in a subgroup of patients with mild essential hypertension who exhibit high cardiac output and evidence of supernormal myocardial contractility. Conversely, the left ventricular functional response to exercise is inversely related to the degree of hypertrophy. High levels of blood viscosity, which would tend to blunt the reduction in peripheral resistance expected during sleep or exercise, have also been associated with left ventricular hypertrophy in patients with essential hypertension. Echocardiographic studies have provided evidence both for and against the hypothesis that activity of the sympathetic or reninangiotensin systems plays a direct role in causing hypertensive cardiac hypertrophy. These findings demonstrate the useful role that echocardiographic assessment of left ventricular structure and function may play in hypertension research.
自从超声心动图测量左心室肌肉质量技术发展以来，在不到十年的时间里，使用该技术的研究已经提供了大量关于人类高血压中左心室肥厚的患病率和病理生理学的信息。在相当一部分系统性高血压患者中发现左心室质量增加，确切的患病率既取决于人群的选择方式，也取决于其成员的性别、种族以及可能的年龄构成。所有已发表的研究都报告称，左心室肥厚与患者在正常活动或运动期间自然状态下记录的血压（无论是通过便携式记录仪还是家用血压计测量）的相关性，比与医生测量的血压的相关性更强。此外，研究表明，同心性左心室肥厚和外周阻力增加等典型的高血压异常是相互关联的，而在表现为高心输出量和超常心肌收缩力证据的轻度原发性高血压患者亚组中不存在左心室肥厚。相反，左心室对运动的功能反应与肥厚程度呈负相关。高血液粘度往往会削弱睡眠或运动期间预期的外周阻力降低，在原发性高血压患者中也与左心室肥厚有关。超声心动图研究为交感神经或肾素 - 血管紧张素系统的活动在导致高血压性心脏肥厚中起直接作用这一假说提供了支持和反对的证据。这些发现证明了超声心动图评估左心室结构和功能在高血压研究中可能发挥的有用作用。
