Muscholl M W, Schunkert H, Muders F, Elsner D, Kuch B, Hense H W, Riegger G A
Department of Cardiology, University of Regensburg, Germany.
Am Heart J. 1998 Jan;135(1):58-66. doi: 10.1016/s0002-8703(98)70343-6.
The purpose of this study was to investigate whether the basal activity of the renin-angiotensin-aldosterone system or the basal levels of the atrial natriuretic peptide (ANP) are related to distinct patterns of left ventricular (LV) geometry in patients with essential hypertension. The left ventricle of patients with arterial hypertension may be exposed to a variety of growth-regulating mechanisms, including pressure overload and humoral activation. The interaction of such growth stimuli may be involved in the modulation of LV geometry. LV geometry was determined echocardiographically in 104 patients with mild to moderate essential hypertension. The same number of age- and sex-matched normotensive subjects served as controls. Plasma renin activity (PRA) and serum concentrations of aldosterone and ANP were measured by radioimmunoassay. Correlation analyses revealed that PRA was significantly associated with septal wall thickness and LV mass index (r = 0.25; p < 0.005 each). In addition, as compared with normal subjects (1.0 +/- 0.7 ng/ml/hr), PRA was significantly increased in patients with concentric LV hypertrophy (LVH) (3.4 +/- 6.6 ng/ml/hr, p < 0.01). Aldosterone displayed a close correlation with septal, posterior, and relative wall thickness (r > 0.27, p < 0.005 each). Compared with normal subjects (74 +/- 27 pg/ml), patients with hypertension and pathologic patterns of LV geometry were characterized by elevations of aldosterone (LV remodeling 203 +/- 93 pg/ml, concentric LVH 123 +/- 67 pg/ml; eccentric LVH 199 +/- 89 pg/ml; p < 0.05 each). ANP was significantly associated with septal wall thickness, left ventricular dimension, and LV mass index (r > 0.22, p < 0.005 each). Furthermore, compared with normal subjects (50 +/- 17 pg/ml), ANP values were significantly increased in patients with hypertension and concentric LVH (80 +/- 44 pg/ml, p < 0.005) and eccentric LVH (88 +/- 24 pg/ml, p < 0.001). Multivariate analysis adjusting for systolic blood pressure, body mass index, and age revealed that renin and ANP were independently associated with LV mass index (p < 0.05 each). Interestingly, adjusted PRA levels were not related to any specific pattern of LV geometry. In contrast, adjusted ANP levels were associated with concentric and eccentric LVH, whereas adjusted aldosterone levels were significantly elevated in subjects with LV remodeling and eccentric LVH (p < 0.005). Thus elevated levels of renin and ANP may be found in patients with hypertension and elevated LV mass index. In addition, ANP and aldosterone are related to specific geometric patterns of the left ventricle. The data may further stimulate the discussion on the mechanisms that account for alterations of LV geometry in hypertension.
本研究旨在探讨肾素 - 血管紧张素 - 醛固酮系统的基础活性或心房利钠肽（ANP）的基础水平是否与原发性高血压患者不同的左心室（LV）几何形态模式相关。动脉高血压患者的左心室可能会受到多种生长调节机制的影响，包括压力超负荷和体液激活。这些生长刺激的相互作用可能参与了左心室几何形态的调节。通过超声心动图测定了104例轻度至中度原发性高血压患者的左心室几何形态。相同数量的年龄和性别匹配的血压正常受试者作为对照。采用放射免疫分析法测定血浆肾素活性（PRA）、醛固酮和ANP的血清浓度。相关性分析显示，PRA与室间隔厚度和左心室质量指数显著相关（r = 0.25；均p < 0.005）。此外，与正常受试者（1.0±0.7 ng/ml/hr）相比，同心性左心室肥厚（LVH）患者的PRA显著升高（3.4±6.6 ng/ml/hr，p < 0.01）。醛固酮与室间隔、后壁和相对壁厚度密切相关（均r > 0.27，p < 0.005）。与正常受试者（74±27 pg/ml）相比，高血压和具有左心室几何形态病理模式的患者醛固酮水平升高（左心室重塑203±93 pg/ml；同心性LVH 123±67 pg/ml；偏心性LVH 199±89 pg/ml；均p < 0.05）。ANP与室间隔厚度、左心室内径和左心室质量指数显著相关（均r > 0.22，p < 0.005）。此外，与正常受试者（50±17 pg/ml）相比，高血压和同心性LVH患者（80±44 pg/ml，p < 0.005）以及偏心性LVH患者（88±24 pg/ml，p < 0.001）的ANP值显著升高。对收缩压、体重指数和年龄进行校正的多变量分析显示，肾素和ANP与左心室质量指数独立相关（均p < 0.05）。有趣的是，校正后的PRA水平与任何特定的左心室几何形态模式均无关。相反，校正后的ANP水平与同心性和偏心性LVH相关，而校正后的醛固酮水平在左心室重塑和偏心性LVH患者中显著升高（p < 0.005）。因此，高血压和左心室质量指数升高的患者可能存在肾素和ANP水平升高的情况。此外，ANP和醛固酮与左心室的特定几何形态模式相关。这些数据可能会进一步激发关于高血压患者左心室几何形态改变机制的讨论。
