Pierdomenico S D, Lapenna D, Guglielmi M D, Porreca E, Antidormi T, Cuccurullo F, Mezzetti A
Hypertension Study and Treatment Center, Institute of Pathophysiology, G. D'Annunzio University, Chieti, Italy.
J Hypertens. 1995 Dec;13(12 Pt 2):1701-6.
To evaluate vascular structural changes in hypertensive patients with different patterns of left ventricular geometry.
From 250 untreated hypertensive patients who underwent ambulatory blood pressure monitoring and echocardiographic study, we selected four groups matched for sex, age, body mass index, smoking habits and serum lipid values: 25 hypertensive subjects with normal left ventricular geometry, 16 with concentric left ventricular remodeling, 26 with concentric left ventricular hypertrophy and 18 with eccentric non-dilated left ventricular hypertrophy. These patients underwent carotid ultrasonography to evaluate the intimal-medial thickness and lumen diameter, and venous occlusion plethysmography to record minimum forearm vascular resistance (an index of arteriolar structural changes).
The intimal-medial thickness and minimum forearm vascular resistance were significantly higher (both P<0.05) in hypertensive subjects with concentric left ventricular remodeling (0.95 mm, 2.68 RU) and concentric left ventricular hypertrophy (0.96 mm, 2.71 RU) than in those with eccentric non-dilated left ventricular hypertrophy (0.81 mm, 2.36 RU) and normal left ventricular geometry (0.71 mm, 2.15 RU). There was no difference between hypertensive patients with concentric left ventricular remodeling and concentric left ventricular hypertrophy. The intimal-medial thickness and minimum forearm vascular resistance tended to be higher in hypertensive subjects with eccentric non-dilated left ventricular hypertrophy than in those with normal left ventricular geometry, but this difference did not attain statistical significance.
This study shows that the spectrum of cardiac adaptation to hypertension is associated with a spectrum of vascular adaptation which might be related both to hemodynamic stimuli and differences in the expression or activity of vascular growth factors.
评估不同左心室几何形态模式的高血压患者的血管结构变化。
从250例接受动态血压监测和超声心动图研究的未治疗高血压患者中，我们选取了四组在性别、年龄、体重指数、吸烟习惯和血脂值方面相匹配的患者：25例左心室几何形态正常的高血压患者，16例左心室向心性重构患者，26例左心室向心性肥厚患者和18例左心室离心性非扩张性肥厚患者。这些患者接受颈动脉超声检查以评估内膜中层厚度和管腔直径，并进行静脉阻塞体积描记法以记录最小前臂血管阻力（小动脉结构变化的指标）。
左心室向心性重构（0.95mm，2.68RU）和左心室向心性肥厚（0.96mm，2.71RU）的高血压患者的内膜中层厚度和最小前臂血管阻力显著高于左心室离心性非扩张性肥厚（0.81mm，2.36RU）和左心室几何形态正常（0.71mm，2.15RU）的患者（均P<0.05）。左心室向心性重构和左心室向心性肥厚的高血压患者之间无差异。左心室离心性非扩张性肥厚的高血压患者的内膜中层厚度和最小前臂血管阻力倾向于高于左心室几何形态正常的患者，但这种差异未达到统计学意义。
本研究表明，心脏对高血压的适应谱与血管适应谱相关，这可能与血流动力学刺激以及血管生长因子的表达或活性差异有关。
