Mayet J, Shahi M, Poulter N R, Sever P S, Thom S A, Foale R A
Department of Cardiology, St Mary's Hospital Medical School, London, UK.
J Hypertens. 1995 Feb;13(2):269-76.
It has been suggested that the increased incidence of sudden death in hypertensive patients, particularly those with left ventricular hypertrophy, may be casually related to the increased number and complexity of ventricular arrhythmias that have been demonstrated in these patients. The objective of the present study was to assess some of the factors which might be responsible for these arrhythmias.
One hundred and three untreated subjects were divided into four groups on the basis of blood pressure and echocardiographic measurements: hypertensive patients with left ventricular hypertrophy (n = 38), hypertensive patients without left ventricular hypertrophy (n = 16), patients with borderline or white-coat hypertension (n = 26) and normotensive subjects (n = 23). Each subject underwent two-dimensional and Doppler echocardiography, 12-lead electrocardiogram examination, 12-lead electrocardiogram exercise stress testing, 24-h ambulatory blood pressure monitoring and 24-h Holter monitoring. A further 17 hypertensive patients with left ventricular hypertrophy who were on long-term antihypertensive therapy were also investigated in the same manner and compared with untreated hypertensive patients with left ventricular hypertrophy who were matched for age, sex and race.
Untreated hypertensive patients, even with left ventricular hypertrophy, had a low prevalence of frequent or complex arrhythmias (seven out of 80 patients with Lown score 2+). In contrast, hypertensive patients with left ventricular hypertrophy on long-term antihypertensive therapy had a significantly greater prevalence of complex arrhythmias than untreated patients with left ventricular hypertrophy (eight out of 17 treated patients compared with two out of 17 untreated patients with Lown score 2+).
Hypertensive patients with left ventricular hypertrophy who had received long-term antihypertensive therapy were found to have a high prevalence of complex ventricular arrhythmias, which was in contrast to untreated hypertensive patients, even those with left ventricular hypertrophy. This may reflect the consequences on the left ventricle of long-term antihypertensive treatment. If complex ventricular arrhythmias are implicated in the excess of sudden deaths in hypertensive patients, this might be an important factor.
有人提出，高血压患者，尤其是左心室肥厚患者猝死发生率增加，可能与这些患者已被证实的室性心律失常数量增加和复杂性增加存在因果关系。本研究的目的是评估可能导致这些心律失常的一些因素。
103名未经治疗的受试者根据血压和超声心动图测量结果分为四组：左心室肥厚的高血压患者（n = 38）、无左心室肥厚的高血压患者（n = 16）、临界或白大衣高血压患者（n = 26）和血压正常的受试者（n = 23）。每位受试者均接受二维和多普勒超声心动图检查、12导联心电图检查、12导联心电图运动负荷试验、24小时动态血压监测和24小时动态心电图监测。另外17名接受长期抗高血压治疗的左心室肥厚高血压患者也以同样的方式进行了研究，并与年龄、性别和种族相匹配的未经治疗的左心室肥厚高血压患者进行了比较。
未经治疗的高血压患者，即使有左心室肥厚，频发或复杂性心律失常的发生率也较低（80例患者中7例洛恩评分2 +）。相比之下，接受长期抗高血压治疗的左心室肥厚高血压患者复杂性心律失常的发生率明显高于未经治疗的左心室肥厚患者（17例治疗患者中有8例，而17例未经治疗患者中有2例洛恩评分2 +）。
发现接受长期抗高血压治疗的左心室肥厚高血压患者复杂性室性心律失常的发生率较高，这与未经治疗的高血压患者，甚至是有左心室肥厚的患者形成对比。这可能反映了长期抗高血压治疗对左心室的影响。如果复杂性室性心律失常与高血压患者猝死过多有关，这可能是一个重要因素。
