Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA.
Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA.
Curr Hypertens Rep. 2019 May 20;21(6):47. doi: 10.1007/s11906-019-0952-9.
The purpose of this review is to answer the question whether left ventricular hypertrophy (LVH) could be considered a therapeutic target in patients with hypertension. To fulfill this purpose, we briefly outline different methods of measuring LVH, then discuss the current evidence and unresolved controversies regarding the relationships among LVH, blood pressure (BP), and cardiovascular disease (CVD) outcomes.
The methods and criteria used for defining LVH in clinical studies lack consistency and are inherently different. Electrocardiogram (ECG) has been the most common method, but some studies used echocardiography, and recently, the cardiac magnetic resonance imaging was used by some studies as well. Regardless of the method, studies have shown that higher BP is a risk factor for LVH, regression of LVH is possible by successful BP lowering, and LVH is associated with CVD outcomes. Nevertheless, recent trials revealed that although intensive BP lowering (systolic BP target of < 120 mm of Hg) resulted in lower rates of developing new ECG-LVH and higher rates of regression of existing LVH, the benefit of intensive BP lowering on the risk of CV events was not meaningfully influenced by its favorable effect on ECG-LVH. These findings raise several critical questions about the mechanistic links between hypertension treatment, LVH regression, and reduction in CV events. Given these questions and findings, LVH improvement cannot yet be considered a reliable surrogate outcome measure for use in the context of hypertensive heart disease. LVH is a modifiable risk factor related to systolic BP and regression of LVH may reduce subsequent CV events. However, LVH may not be the "holy grail" in regard to therapeutic targets in hypertensive heart disease, but it could be considered one of the markers in the successful management of hypertension.
本综述旨在回答左心室肥厚（LVH）是否可被视为高血压患者的治疗靶点这一问题。为了实现这一目的，我们简要概述了测量 LVH 的不同方法，然后讨论了 LVH、血压（BP）和心血管疾病（CVD）结局之间的关系的当前证据和未解决的争议。
临床研究中用于定义 LVH 的方法和标准缺乏一致性，且本质上有所不同。心电图（ECG）是最常用的方法，但有些研究使用超声心动图，最近一些研究也使用心脏磁共振成像。无论采用何种方法，研究表明较高的 BP 是 LVH 的危险因素，成功降压可使 LVH 消退，且 LVH 与 CVD 结局相关。然而，最近的试验表明，尽管强化降压（收缩压目标<120mmHg）可降低新发 ECG-LVH 的发生率和提高现有 LVH 消退的发生率，但强化降压对 CV 事件风险的益处并未因对 ECG-LVH 的有利影响而显著受到影响。这些发现提出了几个关于高血压治疗、LVH 消退和减少 CV 事件之间的机制联系的关键问题。鉴于这些问题和发现，LVH 改善尚不能被视为高血压性心脏病背景下可靠的替代终点测量指标。LVH 是与收缩压相关的可改变的危险因素，LVH 的消退可能会降低随后的 CV 事件发生率。然而，LVH 可能不是高血压性心脏病治疗靶点的“圣杯”，但它可以被视为成功管理高血压的标志物之一。
