Park Seong-Mi, Kim Mi-Na, Kim Sua, Shim Wan-Joo
Division of Cardiology, Korea University Anam Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Korea.
Division of Intensive Care Medicine, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea.
J Clin Med. 2019 Jul 17;8(7):1045. doi: 10.3390/jcm8071045.
Although aldosterone has been demonstrated to induce left ventricular (LV) hypertrophy not only in primary aldosteronism but also in primary hypertension (HT), it can be affected by multiple factors, including age, and the effect of aldosterone on LV function is controversial. This study was to investigate the relationship of aldosterone to changes in LV geometry and function in young adults with never-treated HT.
Seventy-five consecutive patients (age, 29.8 ± 6.3 years) with never-treated HT and 45 normal controls were enrolled. Echocardiographic values and LV global longitudinal strain (LVGLS) were obtained. Serum aldosterone concentration (SAC) and serum procollagen type III amino-terminal peptide (PIIINP) level were obtained in HT patients.
HT patients had higher LV mass index, higher relative wall thickness (RWT), and worse LV function than normal controls. LVGLS and e' velocity were worse in HT patients with normal geometry than in normal controls. SAC was well correlated with LV mass index, RWT, e' velocity, LVGLS, and PIIINP (all < 0.05). LV geometry pattern was most related to SAC among clinical parameters ( = 0.019). LVGLS was most related to LV geometry and diastolic blood pressure. In contrast, e' velocity was most related to PIIINP.
Our findings may indicate that in young patients with never-treated HT, aldosterone significantly contributes to changes in LV geometry and functional impairment through its pro-hypertrophic and myocardial fibrosis effects beyond blood pressure.
尽管已证实醛固酮不仅在原发性醛固酮增多症中，而且在原发性高血压（HT）中均可诱导左心室（LV）肥厚，但它会受到多种因素影响，包括年龄，并且醛固酮对左心室功能的影响存在争议。本研究旨在探讨醛固酮与未经治疗的年轻成年高血压患者左心室几何形态及功能变化之间的关系。
纳入75例连续的未经治疗的高血压患者（年龄29.8±6.3岁）和45例正常对照者。获取超声心动图值及左心室整体纵向应变（LVGLS）。在高血压患者中获取血清醛固酮浓度（SAC）及血清Ⅲ型前胶原氨基末端肽（PIIINP）水平。
高血压患者的左心室质量指数、相对室壁厚度（RWT）更高，左心室功能比正常对照者更差。几何形态正常的高血压患者的LVGLS和e'速度比正常对照者更差。SAC与左心室质量指数、RWT、e'速度、LVGLS及PIIINP均显著相关（均P<0.05）。在临床参数中，左心室几何形态模式与SAC最为相关（P=0.019）。LVGLS与左心室几何形态及舒张压最为相关。相比之下，e'速度与PIIINP最为相关。
我们的研究结果可能表明，在未经治疗的年轻高血压患者中，醛固酮通过其促进肥厚及心肌纤维化作用，在血压之外显著促成左心室几何形态变化及功能损害。
