Schlaich M P, Schmieder R E
Department of Medicine IV, Universität Erlangen-Nürnberg, Nürnberg, Germany.
Am J Hypertens. 1998 Nov;11(11 Pt 1):1394-404. doi: 10.1016/s0895-7061(98)00149-6.
In numerous studies, left ventricular hypertrophy (LVH) has been clearly established to be a strong blood pressure (BP) independent risk factor for cardiovascular morbidity and mortality. In fact, increased echocardiographic left ventricular mass (LVM) has been shown to predict cardiovascular complications not only in patients with arterial hypertension, but also in the general population. Preliminary data revealed that regression of LVH reduced cardiovascular complications. As a consequence, regression of LVH emerged as a desirable goal in patients with echocardiographically determined LVH. These findings raised the question of whether certain antihypertensive drugs differ in their ability to reduce LVM. To resolve this issue, several comparative studies and some metaanalyses have been carried out. Regarding the available data until the end of 1996 including only double-blind, randomized, controlled clinical studies with parallel group design, we found that angiotensin converting enzyme (ACE) inhibitors reduced LVM by 12% (95% CI, 9.0-14.5%), calcium channel blockers by 11% (95% CI, 7.8-13.7%), beta-blockers by 5% (95% CI, 1.2-7.3%), and diuretics by 8% (95% CI, 3.9-11.1%) (overall: P < .01). A similar reduction was found for posterior and septal wall thickness. Thus, ACE inhibitors and calcium channel blockers seemed to be more potent than beta-blockers in their ability to reduce LVH, with diuretics in the intermediate range. The role of new antihypertensive agents such as AT-receptor antagonists cannot be conclusively answered, because the available data source is too small at this time. In addition to the drug class, reduction of LVH seems to be determined by pretreatment LVM, decline in BP, and duration of drug treatment. Further prospective controlled trials will be required to finally evaluate whether the excellent reduction of LVH with ACE inhibitors and calcium channel blockers can be transferred into improved cardiovascular prognosis.
在众多研究中，左心室肥厚（LVH）已被明确证实是心血管发病和死亡的一个强大的独立于血压（BP）的危险因素。事实上，超声心动图显示左心室质量（LVM）增加不仅在动脉高血压患者中，而且在普通人群中都能预测心血管并发症。初步数据显示LVH的消退可减少心血管并发症。因此，LVH的消退成为超声心动图确定有LVH患者的一个理想目标。这些发现提出了一个问题，即某些抗高血压药物在降低LVM的能力上是否存在差异。为解决这个问题，已经进行了几项比较研究和一些荟萃分析。关于截至1996年底的现有数据，这些数据仅包括双盲、随机、对照的平行组设计临床研究，我们发现血管紧张素转换酶（ACE）抑制剂使LVM降低12%（95%CI，9.0 - 14.5%），钙通道阻滞剂使LVM降低11%（95%CI，7.8 - 13.7%），β受体阻滞剂使LVM降低5%（95%CI，1.2 - 7.3%），利尿剂使LVM降低8%（95%CI，3.9 - 11.1%）（总体：P <.01）。后壁和室间隔厚度也有类似程度的降低。因此，ACE抑制剂和钙通道阻滞剂在降低LVH的能力上似乎比β受体阻滞剂更强，利尿剂处于中间范围。由于目前可用的数据源太小，新型抗高血压药物如AT受体拮抗剂的作用尚无法得出定论。除了药物类别外，LVH的降低似乎还取决于治疗前的LVM、血压下降情况和药物治疗持续时间。还需要进一步的前瞻性对照试验来最终评估ACE抑制剂和钙通道阻滞剂对LVH的显著降低是否能转化为改善的心血管预后。
