Shigematsu Y, Hamada M, Okayama H, Hara Y, Hayashi Y, Kodama K, Kohara K, Hiwada K
The Second Department of Internal Medicine, Ehime, University School of Medicine, Shige-nobu-cho, Onsen-gun, Japan.
Hypertension. 1997 Mar;29(3):723-7. doi: 10.1161/01.hyp.29.3.723.
To elucidate whether there is a difference in the progression of target-organ damage between primary aldosteronism and essential hypertension, we compared left ventricular hypertrophy and extracardiac target-organ damage in 23 patients with primary aldosteronism and 116 patients with essential hypertension. The severity of hypertensive retinopathy and the renal involvement in primary aldosteronism were subclinical and similar to those in essential hypertension without left ventricular hypertrophy but significantly milder than those in essential hypertension with left ventricular hypertrophy. There was a strongly significant correlation between the degree of left ventricular mass index and the severity of hypertensive retinopathy and renal involvement independent of office blood pressure in essential hypertension. In contrast, left ventricular hypertrophy markedly progressed despite the mild extracardiac target-organ damage in primary aldosteronism. Left ventricular end-diastolic dimension index in primary aldosteronism (3.16+/-0.50 cm/m2) was significantly larger than in essential hypertension without (2.87+/-0.23) and with (2.88+/-0.22) left ventricular hypertrophy. On the other hand, there was no difference in extracardiac target-organ damage between 13 primary aldosteronism patients with eccentric left ventricular hypertrophy and the 26 essential hypertensive patients with eccentric left ventricular hypertrophy. The results suggest that predominantly volume load, be it due to aldosteronism or other mechanisms, resulting in eccentric left ventricular hypertrophy is less likely to cause extracardiac target-organ damage than hemodynamic or nonhemodynamic mechanisms resulting in concentric left ventricular hypertrophy.
为了阐明原发性醛固酮增多症和原发性高血压在靶器官损害进展方面是否存在差异，我们比较了23例原发性醛固酮增多症患者和116例原发性高血压患者的左心室肥厚及心外靶器官损害情况。原发性醛固酮增多症患者的高血压视网膜病变严重程度及肾脏受累情况为亚临床状态，与无左心室肥厚的原发性高血压患者相似，但明显轻于有左心室肥厚的原发性高血压患者。在原发性高血压中，左心室质量指数与高血压视网膜病变严重程度及肾脏受累情况之间存在高度显著的相关性，且独立于诊室血压。相比之下，尽管原发性醛固酮增多症患者的心外靶器官损害较轻，但左心室肥厚仍明显进展。原发性醛固酮增多症患者的左心室舒张末期内径指数（3.16±0.50 cm/m²）显著大于无左心室肥厚（2.87±0.23）及有左心室肥厚（2.88±0.22）的原发性高血压患者。另一方面，13例有离心性左心室肥厚的原发性醛固酮增多症患者与26例有离心性左心室肥厚的原发性高血压患者在心外靶器官损害方面无差异。结果表明，主要由醛固酮增多症或其他机制导致的容量负荷引起的离心性左心室肥厚，与导致向心性左心室肥厚的血流动力学或非血流动力学机制相比，引起心外靶器官损害的可能性较小。
