Gosse P, Clémenty J
Service de cardiologie, hôpital Saint-André, Bordeaux.
Arch Mal Coeur Vaiss. 1995 Feb;88 Spec No 2:27-9.
Left ventricular hypertrophy is an important risk factor in hypertension and the results of the HYCAR study confirm that it is possible to treat this risk factor independently of an action on the blood pressure. Should systematic echocardiography be performed in every hypertensive patient to diagnose left ventricular hypertrophy and follow up its outcome with treatment? This attitude seems to be premature for two reasons. Firstly, echocardiography, though much more sensitive than electrocardiography for diagnosing left ventricular hypertrophy, has a number of limitations. Good recordings cannot be obtained in all patients; even under the best conditions of reproducibility, the measurement of left ventricular mass is not excellent and does not allow reliable individual follow-up of treatment; even the criteria of left ventricular hypertrophy used at present are open to criticism. Secondly, it remains to be shown whether the reversibility of left ventricular hypertrophy, independently of lowering the blood pressure, improves the prognosis of the hypertensive patient. The intensive research into this problem, further stimulated by the encouraging results of the HYCAR study, should help define the role and value of echocardiography in the future management of hypertension.
左心室肥厚是高血压的一个重要危险因素，HYCAR研究结果证实，有可能独立于对血压的作用来治疗这一危险因素。是否应对每一位高血压患者进行系统的超声心动图检查，以诊断左心室肥厚并随访其治疗结果？这种做法似乎为时过早，原因有二。首先，超声心动图虽然在诊断左心室肥厚方面比心电图敏感得多，但也有一些局限性。并非所有患者都能获得良好的记录；即使在可重复性最佳的条件下，左心室质量的测量也并不完美，无法对个体治疗进行可靠的随访；甚至目前使用的左心室肥厚标准也受到质疑。其次，独立于降低血压之外，左心室肥厚的可逆性是否能改善高血压患者的预后仍有待证实。受HYCAR研究令人鼓舞的结果进一步推动，对这一问题的深入研究应有助于明确超声心动图在未来高血压管理中的作用和价值。
