Ofili E O, Cohen J D, St Vrain J A, Pearson A, Martin T J, Uy N D, Castello R, Labovitz A J
Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Ga 30310, USA.
JAMA. 1998 Mar 11;279(10):778-80. doi: 10.1001/jama.279.10.778.
Left ventricular (LV) hypertrophy is a common problem among elderly patients with isolated systolic hypertension (ISH), but the effect of treatment of ISH on LV mass is not known.
To assess the ability of antihypertensive drug treatment to reduce LV mass in ISH.
Echocardiographic Substudy of the Systolic Hypertension in the Elderly Program (SHEP).
A total of 104 participants at the St Louis SHEP site who had interpretable baseline echocardiograms, 94 of whom had 3-year follow-up echocardiograms.
The SHEP participants were randomized to placebo or active treatment with chlorthalidone (12.5-25 mg/d), with atenolol (25-50 mg/d) added if necessary to maintain goal blood pressure.
Change in LV mass assessed by echocardiography.
Minimum follow-up was 3 years. In the active treatment group, 91% and 80% of subjects were receiving treatment with chlorthalidone alone by the end of years 1 and 3, respectively. The LV mass index was 93 g/m2 in the active treatment group and 100 g/m2 in the placebo group (P<.001). The LV mass index declined by 13% (95% confidence interval, - 3% to - 23%) in the active treatment group compared with a 6% increase (95% confidence interval, - 3% to + 16%) in the placebo group over 3 years (P=.01).
Treatment of ISH with a diuretic-based regimen reduces LV mass.
左心室肥厚是老年单纯收缩期高血压（ISH）患者中的常见问题，但ISH治疗对左心室质量的影响尚不清楚。
评估抗高血压药物治疗降低ISH患者左心室质量的能力。
老年收缩期高血压计划（SHEP）的超声心动图亚研究。
圣路易斯SHEP研究点共有104名参与者有可解释的基线超声心动图，其中94名有3年随访的超声心动图。
SHEP参与者被随机分为安慰剂组或接受氯噻酮（12.5 - 25mg/d）的积极治疗，必要时加用阿替洛尔（25 - 50mg/d）以维持目标血压。
通过超声心动图评估左心室质量的变化。
最短随访3年。在积极治疗组中，分别在第1年末和第3年末，91%和80%的受试者仅接受氯噻酮治疗。积极治疗组的左心室质量指数为93g/m²，安慰剂组为100g/m²（P<0.001）。与安慰剂组3年内左心室质量指数增加6%（95%置信区间，-3%至+16%）相比，积极治疗组左心室质量指数下降了13%（95%置信区间，-3%至-23%）（P = 0.01）。
基于利尿剂的方案治疗ISH可降低左心室质量。
