Sihm I, Schroeder A P, Aalkjaer C, Holm M, Mørn B, Mulvany M, Thygesen K, Lederballe O
Department of Medicine and Cardiology, Aarhus University Hospital, Denmark.
Am J Hypertens. 1995 Oct;8(10 Pt 1):987-96. doi: 10.1016/0895-7061(95)00220-0.
The relations between left ventricular mass (LVM), peripheral resistance artery structure, and ambulatory BP were studied in 83 patients with previously untreated or poorly regulated essential hypertension and 20 healthy controls of similar age and sex. LVM was assessed by echocardiography. Signs of left ventricular hypertrophy (LVH) were present in 67 (81%) of the patients and in none of the controls. Peripheral resistance arteries were isolated from surgical gluteal skin biopsies and mounted in a Mulvany-Halpern isometric small vessel myograph, and their media:lumen ratio, media thickness, and media cross-sectional area were determined under standardized conditions. Mean (+/- SD) ambulatory BP was 122 +/- 9 mm Hg among patients and 96 +/- 8 mm Hg among controls (P < .001). LVM was 327 +/- 99 g among patients and 197 +/- 37 g among controls (P < .001). Media thickness of resistance arteries was 21.0 +/- 4.2 microns among hypertensives and 16.2 +/- 2.6 microns among controls (P < .001). The media:lumen ratio of arteries from patients was 10.2 +/- 2.6% v 7.9 +/- 2.0% in arteries of similar internal diameter from controls (P < .01). Both LVM index (LVMI) and media/lumen ratio correlated significantly with BP. There was significant correlation between media:lumen ratio and LVMI among hypertensive patients (r = 0.45, P < .001), but if patients were subdivided according to the presence of LVH this correlation was found only among patients with LVH (r = 0.60 P< .001) and not among patient without LVH nor controls. Multiple regression analyses of age, body surface area, media/lumen ratio, and BP on LVM or LVMI revealed independent contributions of media/lumen ratio and BP. Age had no influence in the models. Similar results were obtained when casual BP was replaced with ambulatory BP in these analyses. No correlation was found between LVMI and media cross-sectional area. A minor subset of patients with complete absence of nocturnal BP drop had particularly great LVM and media:lumen ratio. The study suggests that cardiac and arteriolar tissue undergo parallel structural remodeling in essential hypertension.
在83例未经治疗或血压控制不佳的原发性高血压患者及20例年龄和性别相近的健康对照者中，研究了左心室质量（LVM）、外周阻力动脉结构与动态血压之间的关系。通过超声心动图评估LVM。67例（81%）患者存在左心室肥厚（LVH）体征，而对照组无一例出现。从手术获取的臀肌皮肤活检组织中分离出外周阻力动脉，安装在Mulvany-Halpern等长小血管肌动描记器上，在标准化条件下测定其内膜与中膜比值、中膜厚度及中膜横截面积。患者的平均（±标准差）动态血压为122±9 mmHg，对照组为96±8 mmHg（P<0.001）。患者的LVM为327±99 g，对照组为197±37 g（P<0.001）。高血压患者阻力动脉的中膜厚度为21.0±4.2微米，对照组为16.2±2.6微米（P<0.001）。患者动脉的内膜与中膜比值为10.2±2.6%，内径相似的对照组动脉为7.9±2.0%（P<0.01）。LVM指数（LVMI）和内膜/中膜比值均与血压显著相关。高血压患者中，内膜与中膜比值和LVMI之间存在显著相关性（r = 0.45，P<0.001），但如果根据是否存在LVH对患者进行细分，这种相关性仅在有LVH的患者中存在（r = 0.60，P<0.001），在无LVH的患者及对照组中均未发现。对年龄、体表面积、内膜/中膜比值和血压对LVM或LVMI进行多元回归分析，结果显示内膜/中膜比值和血压具有独立作用。年龄在模型中无影响。在这些分析中，用动态血压替代偶测血压时，得到了相似的结果。未发现LVMI与中膜横截面积之间存在相关性。一小部分完全没有夜间血压下降的患者具有特别大的LVM和内膜/中膜比值。该研究表明，在原发性高血压中，心脏和小动脉组织经历了平行的结构重塑。
