Department of Cardiology, University Clinical Hospital Center, "Dr. Dragisa Misovic - Dedinje", Belgrade, Serbia.
Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano IRCCS, Meda, Italy.
J Hypertens. 2020 Aug;38(8):1525-1530. doi: 10.1097/HJH.0000000000002432.
We sought to investigate the predictive value of right ventricular (RV) remodeling and 24-h blood pressure (BP) patterns on long-term cardiovascular prognosis in the initially untreated hypertensive patients.
The current study included 505 initially untreated hypertensive patients who were consequently included in this study from 2007 to 2012. All the patients underwent laboratory analysis, 24-h BP monitoring and echocardiographic examination at baseline. The patients were followed for a median period of 9 years. The adverse outcome was defined as the hospitalization due to cardiovascular events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or cardiovascular death).
During the 9-year follow-up period adverse cardiovascular events occurred in 82 hypertensive patients. Night-time SBP, the nondipping BP pattern, left ventricle hypertrophy, RV hypertrophy, right atrial enlargement, RV diastolic dysfunction, and RV systolic dysfunction were associated with adverse cardiovascular events. Nevertheless, night-time SBP, the nondipping BP pattern, mitral E/e', left ventricle hypertrophy, and RV hypertrophy were the only independent predictors of cardiovascular events. When all four BP patterns were included in the model, only the reverse dipping BP pattern was an independent predictor of cardiovascular events.
The present investigation showed that RV hypertrophy and the reverse dipping BP pattern were independent long-term predictors of the cardiovascular outcome. Detailed echocardiographic evaluation and 24-h ambulatory blood pressure monitoring should be performed even in low-risk hypertensive patients.
我们旨在探讨右心室（RV）重构和 24 小时血压（BP）模式对未经治疗的高血压患者长期心血管预后的预测价值。
本研究纳入了 505 例未经治疗的高血压患者，这些患者均于 2007 年至 2012 年期间入组。所有患者在基线时均进行实验室分析、24 小时 BP 监测和超声心动图检查。中位随访时间为 9 年。不良结局定义为因心血管事件（心房颤动、心肌梗死、血运重建、心力衰竭、卒中和心血管死亡）住院。
在 9 年的随访期间，82 例高血压患者发生了不良心血管事件。夜间收缩压、非杓型血压模式、左心室肥厚、RV 肥厚、右心房扩大、RV 舒张功能障碍和 RV 收缩功能障碍与不良心血管事件相关。然而，夜间收缩压、非杓型血压模式、二尖瓣 E/e'、左心室肥厚和 RV 肥厚是心血管事件的唯一独立预测因素。当将所有四种 BP 模式纳入模型时，只有反向杓型血压模式是心血管事件的独立预测因素。
本研究表明，RV 肥厚和反向杓型血压模式是心血管结局的独立长期预测因素。即使在低危高血压患者中，也应进行详细的超声心动图评估和 24 小时动态血压监测。
