King's College London British Heart Foundation Centre, St. Thomas' Hospital, Westminster Bridge.
Evelina Children's Hospital, London, UK.
J Hypertens. 2023 Feb 1;41(2):212-219. doi: 10.1097/HJH.0000000000003326. Epub 2022 Dec 2.
We performed a systematic review and meta-analysis to determine the relative contributions of elevated cardiac output and systemic vascular resistance to hypertension in children and adults. This included 27 studies on 11 765 hypertensive and normotensive children and adults in whom cardiac output was measured. Cardiac output but not systemic vascular resistance was elevated in hypertensive compared to normotensive children and young adults (difference in means 1.15 [0.78-1.52] l/min, P < 0.001). In older hypertensive adults, both were elevated compared to normotensive individuals (0.40 [0.26-0.55] l/min, P < 0.001 and 3.21 [1.91-4.51] mmHg min/l, P < 0.001 for cardiac output and systemic vascular resistance, respectively). The main haemodynamic alteration in primary hypertension (including obesity-hypertension) in both children and young to middle-aged adults is an elevation of cardiac output. With longer duration and greater severity of hypertension there may be progression from a 'cardiac' to a 'vascular' phenotype with increased systemic vascular resistance.
我们进行了系统评价和荟萃分析，以确定心输出量和全身血管阻力对儿童和成人高血压的相对贡献。这包括对 27 项研究的分析，涉及 11765 名患有高血压和血压正常的儿童和成年人，其中测量了心输出量。与血压正常的儿童和年轻人相比，高血压患者的心输出量升高，但全身血管阻力没有升高（平均差异 1.15[0.78-1.52]l/min，P<0.001）。在年龄较大的高血压成年人中，与血压正常的个体相比，两者均升高（心输出量升高 0.40[0.26-0.55]l/min，P<0.001；全身血管阻力升高 3.21[1.91-4.51]mmHg min/l，P<0.001）。原发性高血压（包括肥胖相关高血压）在儿童和年轻到中年成年人中的主要血液动力学改变是心输出量升高。随着高血压持续时间的延长和严重程度的增加，可能会从“心脏”表型进展为“血管”表型，全身血管阻力增加。
