Childhood‐Onset Essential Hypertension and the Family Structure

The prevalence and effect of single‐parent families in childhood‐onset essential hypertension (EH) is unknown. Children with EH and age‐, sex‐, and ethnicity‐matched controls were enrolled. Family structure data were obtained by in‐person interview. A total of 148 families (76 hypertension probands, 72 control probands; median 14 years) were prospective‐ly enrolled in the study. Single‐parent status was seen in 42% of the families––with and without EH (38% vs 46%, P=.41; odds ratio, 0.7; 95% confidence interval, 0.4–1.4). After multivariable analysis, a statistically significant sociofamilial contributor to the development of childhood‐onset EH was not identified. A significant number of single‐parent families (42%), the majority with single mothers, were found in our pedigree study. Sociofamilial factors are known to contribute to the expression of adult‐onset EH, but findings in our study suggest that they appear to contribute less in the expression of childhood‐onset EH.     

高血压左室肥厚诊断的探讨

随机选择104例高血压患者（血压≥160／95mmHg）进行心电图（ECG）和超声心动图（UCG）检查。结果UCG左心室肥厚（LVH）检出率为76％，ECGLVH检出率为24％，ECGLVH患者的左心室重量指数（LVMI）显著增大，伴左心宝功能不全者的LVMI也明显增大，多元相关分析示LVMI与舒张末期左心室内径、室间隔厚度、左室后壁厚度呈显著正相关（P＜0．001）。     

高血压左室肥厚消退的治疗

长期以来 ,人们一直认为左室肥厚 (L VH)是心脏对慢性压力和 /或容量负荷增重的一种适应性反应 ,但近年的流行病学资料已充分证明 ,LVH不仅是高血压病的常见并发症 ,而且是预测心血管病事件和死亡的独立危险因素 [1]。因此 L VH的消退临床意义重大 ,日益成为高血压病研究领域的新热点。本文就 LVH消退的治疗进展作一综述。1　 LVH非药物治疗减轻 L VH的非药物治疗主要是指生活方式的改变 ,包括减轻体重 ,限制钠盐摄入 ,减少酒精摄入 ,加强体育锻炼。这些均可降低动脉压 ,减轻心脏前、后负荷及降低心脏交感神经的兴奋性[2 ] ,对减轻 …     

高血压左室肥厚的不同构型

高血压544例（男性336）和无高血压的配对组204例（男性106），应用心脏超声法对左室构型进行研究，依据相对室壁厚度、左室质量指数的分布、前室间隔及其基底部肥厚程度。6种左室构型检出率分别为:正常左室构型，男女分别占52％，42%；离心性肥厚占16％，25％，性别差异显著（P＜0.001）；向心性重构，男女各占10%，9％；向心性肥厚7％，8％；非对称性室间隔肥厚及前室间隔基底部肥厚型，分别占7%，9％。研究表明左室构型与年龄、性别、病程及收缩压有一定关系，但左室肥厚类型的形成可能取决于心脏内在因素，向心性肥厚与离心性肥厚之间不一定有依从关系。     

超声观察原发性高血压患者左室肥厚与冠脉内皮功能障碍的关系

目的探讨原发性高血压(EH)左室肥厚(LVH)与冠脉内皮功能障碍之间的关系。方法超声观察34例EH患者和15例正常人的心脏结构及功能,此后研究受检者含服硝酸甘油所致的血管非内皮依赖性扩张性(DING),并结合冷加压超声心动图试验评价其冠状动脉内皮依赖性扩张性(DICPT)。结果与正常组(14.98%±1.54%)相比,非LVH(15/34)和LVH(19/34)患者的冠状动脉内皮依赖性扩张性(9.18%±1.12%;4.27%±2.01%)均显著减小,且后者较前者更甚(P<0.001)。LVH组患者的左室重量指数(LVMI)(159.6±29.6)g/m2较非LVH组(98.8±12.8)g/m2及正常组(113.1±13.1)g/m2增大(P<0.001)。LVH组、非LVH组的血压均较正常组增高,但前两组间的血压无显著性差异。3组间的冠脉非内皮依赖性扩张性、EF、FS及年龄、血脂、血糖等无显著性差异(P>0.05)。相关分析显示:患者的左室重量指数与冠状动脉内皮依赖性扩张性呈良好负相关(r=-0.54,P<0.0001)。结论原发性高血压患者左室肥厚与冠脉血管内皮功能障碍密切相关,后者可能在左室肥厚的发生发展过程起作用。     

超声观察原发性高血压患者左室肥厚与冠脉内皮功能障碍的关系

目的探讨原发性高血压(EH)左室肥厚(LVH)与冠脉内皮功能障碍之间的关系.方法超声观察34例EH患者和15例正常人的心脏结构及功能,此后研究受检者含服硝酸甘油所致的血管非内皮依赖性扩张性(DING),并结合冷加压超声心动图试验评价其冠状动脉内皮依赖性扩张性(DICPT).结果与正常组(14.98%±1.54%)相比,非LVH(15/34)和LVH(19/34)患者的冠状动脉内皮依赖性扩张性(9.18%±1.12%;4.27%±2.01%)均显著减小,且后者较前者更甚(P＜0.001).LVH组患者的左室重量指数(LVMI)(159.6±29.6)g/m2较非LVH组(98.8±12.8)g/m2及正常组(113.1±13.1)g/m2增大(P＜0.001).LVH组、非LVH组的血压均较正常组增高,但前两组间的血压无显著性差异.3组间的冠脉非内皮依赖性扩张性、EF、FS及年龄、血脂、血糖等无显著性差异(P＞0.05).相关分析显示患者的左室重量指数与冠状动脉内皮依赖性扩张性呈良好负相关(r=-0.54,P＜0.000 1).结论原发性高血压患者左室肥厚与冠脉血管内皮功能障碍密切相关,后者可能在左室肥厚的发生发展过程起作用.     

B型钠尿肽与原发性高血压及左心室肥厚的研究进展

B型钠尿肽主要生理作用是扩血管、利尿、利钠及抑制血管平滑肌细胞和成纤维细胞增殖,很多研究表明血B型钠尿肽与高血压及左心室肥厚关系密切,可作为一客观血生化指标评估高血压的危险度。在高血压及左心室肥厚的诊断、预后判断及治疗上将发挥重要作用。     

氯沙坦对原发性高血压左心室肥厚的影响

目的：评价一类新型抗高血压药物：血管紧张素Ⅱ受体亚型１拮抗剂氯沙坦对高血压患者血压及左心室肥厚的作用,并与ＡＣＥＩ类药物依那普利进行比较。方法：采用随机、单盲方法;用彩色超声心动图测定左室重量指数（ＬＶＭＩ）等指标,并运用２４ 小时动态血压变化计算谷／峰比值。结果：（１）经６ 个月治疗,氯沙坦组ＬＶＭＩ从１５２．３±２０．５ 降至１２９．４±１４．６ ｇ／ｍ ,Ｐ＜ ０．０５,依那普利组ＬＶＭＩ从１５４．５±１９．５降至１２８．２±１４．８ ｇ／ｍ ,Ｐ＜ ０．０５,其它指标亦有改变,而两组间比较无显著差异;（２）两种药物均有良好的降压作用,但氯沙坦组收缩压和舒张压的谷／峰比值分别为８１％ 和７２％ ,依那普利组分别为７０％ 和６５％ ;（３）服用氯沙坦副作用少,对代谢无明显不良影响。结论：氯沙坦能平稳降低２４ 小时血压,能显著逆转左心室肥厚,其作用与依那普利相近,但副作用少     

高血压左心室肥厚与脉压关系的临床观察

目的　探讨高血压病（essentialhypertension,EH）左心室肥厚（leftventricularhypertrophy,LVH)与脉压（pulsepressure,PP)和大动脉内径变化的关系。方法　应用诊所血压测量和超声心动图检查,测量并计算92例高血压患者脉压,左室重量指数及大动脉内径。分左室肥厚组和无左室肥厚组,分别进行统计学比较。结果　脉压和主动脉根部内径在高血压左室肥厚组和无左室肥厚组之间均有显著性差异（P<0.01）,左室重量指数与脉压（r=0.3,P<0.01）和主动脉根部内径（r=0.5,P<0.01)之间存在一定的正相关。结论　脉压和大动脉内径增大,提示大动脉顺应性下降,在高血压左室肥厚中起重要作用。     

高血压左心室肥厚与脉压关系的临床观察

目的　探讨高血压病 (essentialhypertension ,EH)左心室肥厚 (leftventricularhypertrophy ,LVH)与脉压 (pulsepressure,PP)和大动脉内径变化的关系。方法　应用诊所血压测量和超声心动图检查 ,测量并计算 92例高血压患者脉压 ,左室重量指数及大动脉内径。分左室肥厚组和无左室肥厚组 ,分别进行统计学比较。结果　脉压和主动脉根部内径在高血压左室肥厚组和无左室肥厚组之间均有显著性差异 (P <0 0 1) ,左室重量指数与脉压 (r =0 3,P <0 0 1)和主动脉根部内径 (r =0 5 ,P <0 0 1)之间存在一定的正相关。结论　脉压和大动脉内径增大 ,提示大动脉顺应性下降 ,在高血压左室肥厚中起重要作用     

原发性高血压左心室肥厚与心律失常的关系

目的探讨原发性高血压(EH)病人左心室肥厚(LVH)与心律失常的关系.方法采用24 h动态心电图(DCG)、超声心动图(UCG)对156例EH病人进行检查并分组分析.结果LVH组室性心律失常和复杂室性心律失常的发生率显著高于非LVH组(P＜0.01);房性心律失常的发生率显著高于室性心律失常(P＜0.01).结论左心室肥厚是导致室性心律失常的危险因素之一.     

Left Ventricular Hypertrophy and Hypertension

The level of left ventricular (LV) mass as measured by echocardiography or other techniques in hypertensive patients reflects the integrated effects of the level of arterial pressure, the concomitant volume load imposed on the heart, and of alterations in arterial waveform morphology as well as of body size and non-hemodynamic variables. The LV may respond to these stimuli by concentric or eccentric hypertrophy or by the recently-described pattern of concentric remodeling, in which LV mass is normal but relative wall thickness is increased. The are strong parallelisms between increases in cardiac and systemic arterial wall thicknesses, and patients with discrete atheromas detectable by carotid ultrasound have elevated LV masses. Patients with eccentric and concentric LV hypertrophy have two to four-fold increases in the incidence of cardiovascular morbid events compared to hypertensive patients with normal LV geometry, and the change in LV mass during treatment has been associated with the risk of subsequent morbidity in initial studies. In contrast to the strong predictive power of LV geometric assessment, use of indirect measures of target organ status in the WHO systm for classification of the severity of hypertension does not improve on the prediction of prognosis that can be obtained by consideration of the level of arterial pressure. Current evidence suggests that evaluation of LV geometry may contribute to improved clinical decision-making in situations where more precise stratification of risk would clarify whether or not to institute treatment, or whether it should be with drugs or non-pharmacologic measures.     

糖代谢紊乱对高血压左室肥厚的影响

目的测定高血压患者的糖代谢紊乱情况。方法采用多普勒超声心动图方法测量一组高血压伴与不伴糖尿病患者的左心室重量指数（ＬＶＭＩ）。结果高血压合并糖尿病组的ＬＶ－ＭＩ比单纯高血压组明显增加；空腹血糖与ＬＶＭＩ呈显著正相关（ｒ＝０．８１，Ｐ＜０．０１）。结论提示糖代谢紊乱可能加重或促进高血压病患者的左心室肥厚     

高血压左室肥厚患者冠状动脉血流储备研究

用电子计算机分析造影剂前缘移动平均速度和冠脉内径测定冠脉血流,发现高血压伴左室肥厚组（14例）静息时左前降支血流量和右冠脉血流速度、血流量高于血压正常对照组（26例）。注射罂粟碱后,高血压组两支血管的血流速度和血流量与对照组相似,但血流储备明显减低。因此,高血压左室肥厚患者的冠脉血流储备减低,可能与这些患者静息时冠脉血流增高有关。     

胰岛素抵抗与原发性高血压患者合并左心室肥厚的关系

目的：研究胰岛素抵抗与原发性高血压合并左心室心肌肥厚的关系。　　方法：选择４４例原发性高血压（ＥＨ）患者为ＥＨ组,３６ 例ＥＨ合并左心室肥厚（ＬＶＨ）患者为ＥＨ＋ ＬＶＨ组和３８ 例正常血压者为正常血压组。用二维超声心动图测定上述３组左心室重量指数、总心室壁厚度和相对心室壁厚度及血糖、胰岛素并计算胰岛素敏感指数。　　结果：方差分析发现正常血压组和ＥＨ组中胰岛素敏感指数明显高于ＥＨ＋ ＬＶＨ组（Ｐ＜ ０．０５）。在直线回归分析中发现胰岛素敏感指数与左心室重量指数明显负相关（ｒ＝ － ０．３０１,Ｐ＜ ０．０５）。胰岛素敏感指数与总心室壁厚度明显负相关（ｒ＝ － ０．２８８,Ｐ＜ ０．０５）。逐步回归分析提示左心室重量指数与胰岛素敏感指数、高血压年限、总外周血管阻力显著相关（Ｒ２＝ ０．２９３５,Ｐ＜ ０．０１）。　　结论：提示胰岛素抵抗在原发性高血压合并ＬＶＨ的发病机制中具有重要的作用     

依那普利对高血压左室肥厚的逆转效应

本文对依那普利治疗原发性高血压时的左室肥厚逆转效应进行观察。根据心超LVMI分为肥厚组 (2 4例 )和非肥厚组 (13例 )。疗程 4周 ,剂量 10～ 40mg/d。结果显示左室肥厚的逆转效应在短期 (4周 )治疗后可出现 ,首先是IVST的下降。对左室无肥厚者起相反效应     

The Effects of Simvastatin on Left Ventricular Hypertrophy and Left Ventricular Function in Patients with Essential Hypertension

This study is to evaluate the effects of Simvastatin on left ventricular hypertrophy and left ventricular function in patients with essential hypertension. Untreated or noncompliance with drug treatment patients with simple essential hypertension were treated with a therapy on the basis of using Telmisartan to decrease blood pressure (BP). There were 237 patients who had essential hypertension combined with left ventricular hypertrophy as diagnosed by echocardiography, taken after their BPs were decreased to meet the values of the standard normal. Among them, there were only 41 out of the original 237 patients, 17.3%, who had simple essential hypertension combined with left ventricular hypertrophy without any other co-existing disease. They were the patients selected for this study. All patients were randomly, indiscriminately divided into two groups: one was the control group (Group T), treated with the Telmisartan-based monotherapy; the other was the target group (Group TS), treated with the Telmisartan-based plus simvastatin therapy. The changes of left ventricular hypertrophy and left ventricular function were rediagnosed by echocardiography after 1 year. The results we obtained from this study were as follows: (i) The average BPs at the beginning of the study, of simple essential hypertension combined with left ventricular hypertrophy, were high levels (systolic blood pressure (SBP) 189.21 ± 19.91 mm Hg, diastolic blood pressure 101.40 ± 16.92 mm Hg). (ii) The Telmisartan-based plus simvastatin therapy was significantly effective in lowering the SBP (128.26 ± 9.33 mm Hg vs. 139.22 ± 16.34 mm Hg). (iii) After the 1-year treatment, the parameters of left ventricular hypertrophy in both groups were improved. Compared to group T, there were no differences in the characteristics of the subjects, including interventricular septum, left ventricular mass, left ventricular mass index, ejection fraction, left atrium inner diameter at baseline. The patients’ interventricular septum (Group TS 10.30 ± 1.80 mm vs. Group T 10.99 ± 1.68 mm, P < .05), LVM (Group TS 177.43 ± 65.40 g vs. Group T 181.28 ± 65.09 g, P < .05), and LVMI (Group TS 100.97 ± 37.33 g/m² vs. Group T 106.54 ± 27.95 g/m², P < .05), all dropped more prominently (P < .05) in group TS; the ejection fraction rose more remarkably in group TS (Group TS: 57.50 ± 16.41% to 65.43 ± 11.60%, P < .01 while showing no change in Group T); the left ventricular hypertrophy reversed more significantly and the left ventricular systolic function improved more. (iv) The left atrium inner diameter of Group TS decreased (P < .01), the ratio of E/A, which indicates the left ventricular diastolic function, continued to drop further, showing no change to the trend of left ventricular diastolic function declination. Patients who have hypertension with left ventricular hypertrophy usually suffer other accompanying diseases at the same time. Telmisartan-based plus Simvastatin treatment can significantly reduce SBP, reverse left ventricular hypertrophy, improve the left ventricular systolic function, but it has no effect on reversing the left ventricular diastolic function. This experiment indicated that Simvastatin can reverse left ventricular hypertrophy and improve left systolic function.     

血浆甲状旁腺激素与高血压左室肥厚的关系

血浆甲状旁腺激素与高血压左室肥厚的关系惠永明陈新根王策西华（电力总医院心内科，北京１０００７３）ＰａｒａｔｈｏｒｍｏｎｅａｎｄＶｅｎｔｒｉｃｕｌａｒＨｙｐｅｒｔｒｏｐｈｙｉｎＥｓｓｅｎｔｉａｌＨｙｐｅｒｔｅｎｓｉｏｎＨｕｉＹｏｎｇｍｉｎｇ，ＣｈｅｎＸ...     

Hypertension Images: Electrocardiographic Left Ventricular Hypertrophy

The electrocardiogram is an inexpensive adjunct for assessing target organ damage in hypertensive patients. The gender-specific Cornell voltage criteria (men: R_aVL+ S_V3 >35 mm; women: R_aVL+ S_V3 >25 mm) have better overall accuracy than the often-used Soko low-Lyon or Romhilt-Estes criteria. One of the earliest electrocardiographic findings of hypertensive heart disease is a duration of the negative phase of the P wave in chest lead V₁ of >0.04 seconds, a manifestation of left atrial enlargement or abnormality. There is no other cardiovascular risk factor more potent than left ventricular hypertrophy with a "strain pattern." Despite limitations in determining hypertensive heart disease, the electrocardiogram provides other information that is useful in the management of patients with hypertension.     

伴左室肥厚高血压病患者发生室性心律失常临床意义的探讨

对１２９例高血压病患者进行２４小时动态心电图监测，分析室性心律失常的发生。结果表明：伴左室肥厚高血压组（ｎ＝４８）复杂室性心律失常（按Ｌｏｗｎ分级≥ＩＩＩ级）的发生率显著高于无左室肥厚的高血压组（ｎ＝８１），７０．８％ＶＳ１３．６％，Ｐ＜０．００５；复杂室性心律失常昼夜变化以晨６时至正午１２时发生率较高。提示高血压病左室肥厚存在复杂室性心律失常易发性及致心律失常源的基础。积极逆转左室肥厚、改善心肌缺血及抗室性心律失常的治疗是有意义的。