Chaturvedi N, Athanassopoulos G, McKeigue P M, Marmot M G, Nihoyannopoulos P
Department of Epidemiology and Public Health, University College London Medical School, England, United Kingdom.
J Am Coll Cardiol. 1994 Nov 15;24(6):1499-505. doi: 10.1016/0735-1097(94)90146-5.
This study attempted to determine whether people of black African descent have more left ventricular hypertrophy than those of white European descent and whether this can be explained by rest or ambulatory blood pressure.
Mortality associated with hypertension is higher in black populations than among whites, but differences in morbidity and their associations with blood pressure are inconsistent.
We examined 1,166 black and white men and women 40 to 64 years old in a community survey in London, United Kingdom. Echocardiograms were obtained for all subjects and ambulatory blood pressure recordings for 319.
Adjusted for body size, ventricular septal thickness was greater in blacks than whites (p < 0.05), and cavity dimension was smaller (p < 0.05). In men, ventricular septal thickness was > 10 mm for 32% of whites and 53% of blacks; for women these figures were 14% and 38%, respectively. Relative wall thickness was greater in blacks (p < 0.01 for men and women), but left ventricular mass index was similar in the two ethnic groups. In men, hypertension resulted in an increase in wall thickness in both ethnic groups, but cavity dimension decreased in blacks and increased in whites. Wall thickness was higher in blacks than in whites for equivalent levels of either rest (p = 0.05) or ambulatory (p = 0.007) blood pressure.
Left ventricular mass index may not be valid for comparison between ethnic groups because this derived measure does not take into account ethnic differences in ventricular structural response to hypertension. Interventricular wall thickness may be more valid. Using this measure, we demonstrate greater ventricular hypertrophy in blacks than in whites, unexplained by differences in either rest or ambulatory blood pressure. The pattern of ventricular hypertrophy observed in blacks is associated with an increased mortality risk. Conventional blood pressure thresholds for instituting antihypertensive treatment may be too conservative for people of black African descent.
本研究试图确定非洲裔黑人是否比欧洲裔白人有更多的左心室肥厚，以及这是否可以用静息血压或动态血压来解释。
黑人人群中与高血压相关的死亡率高于白人，但发病率差异及其与血压的关联并不一致。
在英国伦敦的一项社区调查中，我们对1166名40至64岁的黑人和白人男性及女性进行了检查。所有受试者均进行了超声心动图检查，319人进行了动态血压记录。
调整身体大小后，黑人的室间隔厚度大于白人（p<0.05），而腔径较小（p<0.05）。在男性中，32%的白人室间隔厚度>10mm，53%的黑人室间隔厚度>10mm；在女性中，这两个数字分别为14%和38%。黑人的相对壁厚更大（男性和女性p<0.01），但两个种族的左心室质量指数相似。在男性中，高血压导致两个种族的壁厚增加，但黑人的腔径减小，白人的腔径增加。在静息血压（p=0.05）或动态血压（p=0.007）相当的水平下，黑人的壁厚高于白人。
左心室质量指数可能不适用于不同种族之间的比较，因为这种派生指标没有考虑到心室对高血压的结构反应中的种族差异。室间隔厚度可能更有效。使用这个指标，我们证明黑人比白人有更大的心室肥厚，静息血压或动态血压的差异无法解释这种现象。在黑人中观察到的心室肥厚模式与死亡风险增加有关。对于非洲裔黑人，常规的启动降压治疗的血压阈值可能过于保守。
