Borhani N O
Department of Community Health, University of California, School of Medicine, Davis 95616.
Am J Cardiol. 1987 Dec 14;60(17):13I-18I. doi: 10.1016/0002-9149(87)90453-x.
Left ventricular (LV) hypertrophy is a significant independent risk factor for mortality from coronary heart disease, including sudden death. The proportion of sudden death to total death due to coronary heart disease remains high, at about 50% to 60%, despite the continuing downward trend in coronary heart disease mortality observed in the U.S. during the last decade. Prevalence of LV hypertrophy, determined by electrocardiogram in hypertensive patients (diastolic blood pressure greater than or equal to 90 mm Hg), including tall R wave and evidence of repolarization abnormality, is around 5%. The prevalence of LV hypertrophy by echocardiography is estimated at 44% to 48%. LV hypertrophy on electrocardiogram underestimates the magnitude of the problem of LV hypertrophy in hypertensive patients. Its overall sensitivity is less than 60%. The incidence of LV hypertrophy in hypertensive patients is lower when hypertension is treated successfully than when the patient is left either untreated or inadequately treated; successful treatment of hypertension causes regression of LV hypertrophy. However, hypertensive patients with LV hypertrophy have a poor prognosis despite treatment. The available evidence derived from the results of large clinical trials suggests that hypertensive patients should be treated before there is electrocardiographic evidence of LV hypertrophy.
左心室肥厚是冠心病死亡（包括猝死）的一个重要独立危险因素。尽管过去十年美国冠心病死亡率持续下降，但冠心病猝死占总死亡的比例仍然很高，约为50%至60%。通过心电图确定的高血压患者（舒张压大于或等于90毫米汞柱）左心室肥厚患病率，包括高R波和复极异常证据，约为5%。通过超声心动图估计的左心室肥厚患病率为44%至48%。心电图上的左心室肥厚低估了高血压患者左心室肥厚问题的严重程度。其总体敏感性低于60%。成功治疗高血压时，高血压患者左心室肥厚的发生率低于未治疗或治疗不充分的患者；成功治疗高血压可使左心室肥厚消退。然而，尽管接受了治疗，左心室肥厚的高血压患者预后仍较差。来自大型临床试验结果的现有证据表明，高血压患者应在出现心电图左心室肥厚证据之前接受治疗。
