Otterstad J E
Medical Department, Vestfold Central Hospital, Toensberg, Norway.
Eur Heart J. 1993 Oct;14 Suppl F:2-6. doi: 10.1093/eurheartj/14.suppl_f.2.
Left ventricular hypertrophy (LVH), diagnosed by ECG and echocardiography, is commonly associated with coronary heart disease. Hypertensive patients with LVH and myocardial ischaemia may be at particular risk. The prevalence of ischaemia in hypertensive LVH was addressed in THAMES (Tenormin in Hypertension and Myocardial Ischaemia Epidemiological Survey), which comprised 205 men with hypertension. Echocardiography revealed LVH (defined as a left ventricular mass index > or = 130 g m-2) in 140 patients (68%). Of these patients with LVH, myocardial ischaemia was diagnosed on exercise ECG testing in 24%, and by thallium scintigraphy in 14%. Although not proven, a logical approach would be to improve the prognosis by reversing LVH and reducing ischaemia. A recent meta-analysis has indicated that angiotensin-converting enzyme (ACE) inhibitors are the most effective drugs in reversing LVH. But beta-blockers may still be a logical first choice of drug, because of their valuable anti-ischaemic properties.
通过心电图和超声心动图诊断出的左心室肥厚（LVH）通常与冠心病有关。患有LVH和心肌缺血的高血压患者可能面临特殊风险。THAMES（高血压与心肌缺血流行病学调查中的氨酰心安）研究探讨了高血压LVH患者中缺血的患病率，该研究纳入了205名高血压男性。超声心动图显示140名患者（68%）存在LVH（定义为左心室质量指数≥130 g/m²）。在这些LVH患者中，24%通过运动心电图检测诊断出心肌缺血，14%通过铊闪烁扫描诊断出心肌缺血。虽然未经证实，但一种合理的方法是通过逆转LVH和减轻缺血来改善预后。最近的一项荟萃分析表明，血管紧张素转换酶（ACE）抑制剂是逆转LVH最有效的药物。但由于β受体阻滞剂具有宝贵的抗缺血特性，它们可能仍然是合理的首选药物。
