高血压成年人动脉结构和功能与左心室几何形态的关系。

Relation of arterial structure and function to left ventricular geometric patterns in hypertensive adults.

作者信息

Roman M J, Pickering T G, Schwartz J E, Pini R, Devereux R B

机构信息

Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021, USA.

出版信息

J Am Coll Cardiol. 1996 Sep;28(3):751-6. doi: 10.1016/0735-1097(96)00225-2.

DOI:10.1016/0735-1097(96)00225-2

PMID:8772767

Abstract

OBJECTIVES

The present study sought to determine whether conduit artery structure and function vary according to the pattern of left ventricular adaptation to hypertension.

BACKGROUND

Although left ventricular geometric pattern has been shown to predict cardiovascular events in hypertension, the arterial status in patients with the different patterns is unknown.

METHODS

We evaluated arterial structure and function by carotid ultrasound and applanation tonometry in 271 unmedicated hypertensive patients classified by echocardiography as having normal ventricular geometry (n = 176), concentric remodeling (n = 54), concentric hypertrophy (n = 16) or eccentric hypertrophy (n = 25).

RESULTS

All groups were similar in age, gender distribution and body size. Patients with concentric and eccentric hypertrophy had similar blood pressures (mean 173/100 and 171/99 mm Hg, respectively) and left ventricular mass, but compared with patients with normal left ventricular geometry and concentric remodeling, only those with concentric hypertrophy had increased arterial wall thickness (0.96 +/- 0.20 vs. 0.80 +/- 0.18 mm, p < 0.05), end-diastolic diameter (6.38 +/- 0.97 vs. 5.76 +/- 0.87 mm, p < 0.05), cross-sectional area (22.1 +/- 5.71 vs. 16.6 +/- 5.4 mm(1)2 p < 0.05) and elastic modulus (713 +/- 265 vs. 471 +/- 241 dynes/cm2 x 10(-5), p < 0.05). Patients with concentric remodeling and eccentric hypertrophy had similar values for these measures (0.85 +/- 0.22 and 0.89 +/- 0.21 mm, 5.67 +/- 0.77 and 6.04 +/- 0.44 mm, 17.2 +/- 5.4 and 19.7 +/- 5.9 mm2, 558 +/- 263 and 614 +/- 257 dynes/cm2 x 10(-6), respectively), despite lower systolic blood pressures in the former group (156/94 mm Hg, p < 0.001). The prevalence of plaque was comparable in patients with concentric (56%) and eccentric (42%) hypertrophy and significantly greater than that in patients [corrected] with normal geometry (21%).

CONCLUSIONS

Among patients with generally mild, uncomplicated systemic hypertension, arterial structure and function are most abnormal when concentric left ventricular hypertrophy is present and may contribute to the more adverse outcome associated with this geometric pattern.

摘要

目的

本研究旨在确定输送动脉的结构和功能是否会根据左心室对高血压的适应模式而有所不同。

背景

尽管左心室几何模式已被证明可预测高血压患者的心血管事件，但不同模式患者的动脉状况尚不清楚。

方法

我们通过颈动脉超声和压平式眼压测量法评估了271例未经药物治疗的高血压患者的动脉结构和功能，这些患者经超声心动图分类为具有正常心室几何结构（n = 176）、向心性重塑（n = 54）、向心性肥厚（n = 16）或离心性肥厚（n = 25）。

结果

所有组在年龄、性别分布和体型方面相似。向心性和离心性肥厚患者的血压（分别为平均173/100和171/99 mmHg）和左心室质量相似，但与左心室几何结构正常和向心性重塑的患者相比，只有向心性肥厚患者的动脉壁厚度增加（0.96±0.20 vs. 0.80±0.18 mm，p < 0.05）、舒张末期直径增加（6.38±0.97 vs. 5.76±0.87 mm，p < 0.05）、横截面积增加（22.1±5.71 vs. 16.6±5.4 mm²，p < 0.05）和弹性模量增加（713±265 vs. 471±241达因/cm²×10⁻⁵，p < 0.05）。向心性重塑和离心性肥厚患者的这些测量值相似（分别为0.85±0.22和0.89±0.21 mm、5.67±0.77和6.04±0.44 mm、17.2±5.4和19.7±5.9 mm²、558±263和614±257达因/cm²×10⁻⁶），尽管前一组的收缩压较低（156/94 mmHg，p < 0.001）。向心性（56%）和离心性（42%）肥厚患者的斑块患病率相当，且显著高于几何结构正常的患者（21%）。