Chu Hyun-Wook, Hwang In-Chang, Kim Hyue Mee, Park Jiesuck, Choi Hyejung, Choi Hong-Mi, Yoon Yeonyee E, Cho Goo-Yeong
Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Hypertens Res. 2024 May;47(5):1144-1156. doi: 10.1038/s41440-023-01571-w. Epub 2024 Jan 18.
Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular mortality and morbidity in patients with hypertension. However, the effect of age on LVH regression or persistence and its differential prognostic value remain unclear. Therefore, we investigated the clinical implications of LVH regression in 1847 patients with hypertension and echocardiography data (at baseline and during antihypertensive treatment at an interval of 6-18 months) according to age. LVH was defined as a left ventricular mass index (LVMI) > 115 g/m and >95 g/m in men and women, respectively. LVH prevalence at baseline was not different according to age (age < 65 years: 42.6%; age ≥65 years: 45.7%; p = 0.187), but LVH regression was more frequently observed in the younger group (36.4% vs. 27.5%; p = 0.008). Spline curves and multiple linear regression analysis showed a significant relationship between reductions in systolic blood pressure and LVMI in the younger group (β = 0.425; p < 0.001), but not the elderly group (β = 0.044; p = 0.308). LVH regression was associated with a lower risk of the study outcome (composite of cardiovascular death and hospitalization for heart failure) regardless of age. In conclusion, the association between the reduction in blood pressure and LVH regression was prominent in patients with age < 65 years, but not in those with age ≥65 years. However, an association between LVH regression and lower risk of cardiovascular death and hospitalization for heart failure was observed regardless of patient age, suggesting the prognostic value of the LVH regression not only in the younger patients but also in elderly patients.
左心室肥厚（LVH）是高血压患者心血管病死亡率和发病率的重要危险因素。然而，年龄对LVH消退或持续存在的影响及其不同的预后价值仍不清楚。因此，我们根据年龄对1847例高血压患者的LVH消退情况及超声心动图数据（基线时以及降压治疗期间，间隔6 - 18个月）进行了临床研究。LVH定义为男性左心室质量指数（LVMI）>115 g/m²，女性>95 g/m²。基线时LVH患病率在不同年龄组间无差异（年龄<65岁：42.6%；年龄≥65岁：45.7%；p = 0.187），但较年轻组更频繁观察到LVH消退（36.4%对27.5%；p = 0.008）。样条曲线和多元线性回归分析显示，较年轻组收缩压降低与LVMI降低之间存在显著关系（β = 0.425；p < 0.001），而老年组则无此关系（β = 0.044；p = 0.308）。无论年龄如何，LVH消退与研究结局（心血管死亡和因心力衰竭住院的复合终点）风险较低相关。总之，血压降低与LVH消退之间的关联在年龄<65岁的患者中显著，但在年龄≥65岁的患者中不显著。然而，无论患者年龄如何，均观察到LVH消退与心血管死亡和因心力衰竭住院风险较低之间存在关联，这表明LVH消退不仅对年轻患者，而且对老年患者均具有预后价值。
