UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

高血压患者左心室肥大的临床意义及治疗

Authors
Norman M Kaplan, MD
Pamela S Douglas, MD
Section Editor
George L Bakris, MD
Deputy Editor
John P Forman, MD, MSc
Translators
刘莹, 主任医师，教授

引言

左心室肥大(left ventricular hypertrophy, LVH)是高血压患者的常见表现，左心室肥大可以通过心电图(electrocardiogram, ECG)或超声心动图来诊断[1]。不同的心电图诊断标准的敏感性对轻度LVH可低至7%-35%，对中到重度病情也只有10%-50%，因此超声心动图是首选的诊断方法[2]。然而，如果超声心动图不可用或太昂贵，可使用适当的心电图诊断标准来检测左心室(left ventricular,LV)质量的增加[3]。

高血压患者LVH的临床意义及治疗将总结在此。高血压患者这种并发症(LVH)的定义及发病机制将单独讨论。 (参见“高血压患者左心室肥厚的定义与发病机制”)

LVH与心血管病风险的增加

LVH的存在(通过心电图或超声心动图诊断)具有很重要的临床意义，因为这与心力衰竭、室性心律失常、心肌梗死(myocardial infarction, MI)后死亡、左心室射血分数下降、心脏性猝死、主动脉根部扩张及脑血管事件的发生率增加相关。

超声心动图诊断出的LVH(超声心动图比ECG敏感得多)还能使心脏事件(包括心绞痛、心肌梗死、心力衰竭、严重的室性心律失常)、脑卒中和心血管死亡的风险增加[4-10]。此外心血管风险的增加与左心室质量的增加程度直接相关(图 1和图 2)[4,6-8]，这种效应不依赖于血压(blood pressure, BP)[5]。

研究发现的范围通过以下观察报告阐明：

        

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2017-06-30.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Elias MF, Sullivan LM, Elias PK, et al. Left ventricular mass, blood pressure, and lowered cognitive performance in the Framingham offspring. Hypertension 2007; 49:439.
  2. Barrios V, Escobar C, Calderon A, et al. Prevalence of left ventricular hypertrophy detected by Cornell voltage-duration product in a hypertensive population. Blood Press 2008; 17:110.
  3. Ang D, Lang C. The prognostic value of the ECG in hypertension: where are we now? J Hum Hypertens 2008; 22:460.
  4. Levy D, Garrison RJ, Savage DD, et al. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990; 322:1561.
  5. Koren MJ, Devereux RB, Casale PN, et al. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 1991; 114:345.
  6. Verdecchia P, Carini G, Circo A, et al. Left ventricular mass and cardiovascular morbidity in essential hypertension: the MAVI study. J Am Coll Cardiol 2001; 38:1829.
  7. Haider AW, Larson MG, Benjamin EJ, Levy D. Increased left ventricular mass and hypertrophy are associated with increased risk for sudden death. J Am Coll Cardiol 1998; 32:1454.
  8. Verdecchia P, Porcellati C, Reboldi G, et al. Left ventricular hypertrophy as an independent predictor of acute cerebrovascular events in essential hypertension. Circulation 2001; 104:2039.
  9. Drazner MH, Rame JE, Marino EK, et al. Increased left ventricular mass is a risk factor for the development of a depressed left ventricular ejection fraction within five years: the Cardiovascular Health Study. J Am Coll Cardiol 2004; 43:2207.
  10. Levy D, Garrison RJ, Savage DD, et al. Left ventricular mass and incidence of coronary heart disease in an elderly cohort. The Framingham Heart Study. Ann Intern Med 1989; 110:101.
  11. Beache GM, Herzka DA, Boxerman JL, et al. Attenuated myocardial vasodilator response in patients with hypertensive hypertrophy revealed by oxygenation-dependent magnetic resonance imaging. Circulation 2001; 104:1214.
  12. Carluccio E, Tommasi S, Bentivoglio M, et al. Prognostic value of left ventricular hypertrophy and geometry in patients with a first, uncomplicated myocardial infarction. Int J Cardiol 2000; 74:177.
  13. Burke AP, Farb A, Liang YH, et al. Effect of hypertension and cardiac hypertrophy on coronary artery morphology in sudden cardiac death. Circulation 1996; 94:3138.
  14. Norton GR, Woodiwiss AJ, Gaasch WH, et al. Heart failure in pressure overload hypertrophy. The relative roles of ventricular remodeling and myocardial dysfunction. J Am Coll Cardiol 2002; 39:664.
  15. Gardin JM, McClelland R, Kitzman D, et al. M-mode echocardiographic predictors of six- to seven-year incidence of coronary heart disease, stroke, congestive heart failure, and mortality in an elderly cohort (the Cardiovascular Health Study). Am J Cardiol 2001; 87:1051.
  16. Okin PM, Wachtell K, Devereux RB, et al. Regression of electrocardiographic left ventricular hypertrophy and decreased incidence of new-onset atrial fibrillation in patients with hypertension. JAMA 2006; 296:1242.
  17. Levy D, Salomon M, D'Agostino RB, et al. Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. Circulation 1994; 90:1786.
  18. Klingbeil AU, Schneider M, Martus P, et al. A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension. Am J Med 2003; 115:41.
  19. Ruggenenti P, Iliev I, Costa GM, et al. Preventing left ventricular hypertrophy by ACE inhibition in hypertensive patients with type 2 diabetes: a prespecified analysis of the Bergamo Nephrologic Diabetes Complications Trial (BENEDICT). Diabetes Care 2008; 31:1629.
  20. Ruilope LM, Schmieder RE. Left ventricular hypertrophy and clinical outcomes in hypertensive patients. Am J Hypertens 2008; 21:500.
  21. Franz IW, Tönnesmann U, Müller JF. Time course of complete normalization of left ventricular hypertrophy during long-term antihypertensive therapy with angiotensin converting enzyme inhibitors. Am J Hypertens 1998; 11:631.
  22. Cuspidi C, Negri F, Zanchetti A. Angiotensin II receptor blockers and cardiovascular protection: focus on left ventricular hypertrophy regression and atrial fibrillation prevention. Vasc Health Risk Manag 2008; 4:67.
  23. Okin PM, Devereux RB, Gerdts E, et al. Impact of diabetes mellitus on regression of electrocardiographic left ventricular hypertrophy and the prediction of outcome during antihypertensive therapy: the Losartan Intervention For Endpoint (LIFE) Reduction in Hypertension Study. Circulation 2006; 113:1588.
  24. Os I, Franco V, Kjeldsen SE, et al. Effects of losartan in women with hypertension and left ventricular hypertrophy: results from the Losartan Intervention for Endpoint Reduction in Hypertension Study. Hypertension 2008; 51:1103.
  25. Solomon SD, Appelbaum E, Manning WJ, et al. Effect of the direct Renin inhibitor aliskiren, the Angiotensin receptor blocker losartan, or both on left ventricular mass in patients with hypertension and left ventricular hypertrophy. Circulation 2009; 119:530.
  26. Devereux RB, Palmieri V, Sharpe N, et al. Effects of once-daily angiotensin-converting enzyme inhibition and calcium channel blockade-based antihypertensive treatment regimens on left ventricular hypertrophy and diastolic filling in hypertension: the prospective randomized enalapril study evaluating regression of ventricular enlargement (preserve) trial. Circulation 2001; 104:1248.
  27. Wachtell K, Palmieri V, Olsen MH, et al. Change in systolic left ventricular performance after 3 years of antihypertensive treatment: the Losartan Intervention for Endpoint (LIFE) Study. Circulation 2002; 106:227.
  28. Rials SJ, Wu Y, Xu X, et al. Regression of left ventricular hypertrophy with captopril restores normal ventricular action potential duration, dispersion of refractoriness, and vulnerability to inducible ventricular fibrillation. Circulation 1997; 96:1330.
  29. Wachtell K, Bella JN, Rokkedal J, et al. Change in diastolic left ventricular filling after one year of antihypertensive treatment: The Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) Study. Circulation 2002; 105:1071.
  30. Okin PM, Devereux RB, Jern S, et al. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major cardiovascular events. JAMA 2004; 292:2343.
  31. Pierdomenico SD, Lapenna D, Cuccurullo F. Regression of echocardiographic left ventricular hypertrophy after 2 years of therapy reduces cardiovascular risk in patients with essential hypertension. Am J Hypertens 2008; 21:464.
  32. Ang DS, Fahey TP, Wright GA, Struthers AD. Development and validation of a clinical score to identify echocardiographic left ventricular hypertrophy in patients with cardiovascular disease. Am J Hypertens 2008; 21:1011.
  33. Sheps SG, Frohlich ED. Limited echocardiography for hypertensive left ventricular hypertrophy. Hypertension 1997; 29:560.
  34. Verdecchia P, Sleight P, Mancia G, et al. Effects of telmisartan, ramipril, and their combination on left ventricular hypertrophy in individuals at high vascular risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease. Circulation 2009; 120:1380.