Background: Increased relative wall thickness in hypertensive left ventricular hypertrophy (LVH) has been shown by echocardiography to allow preserved shortening at the endocardium despite depressed LV midwall circumf...Background: Increased relative wall thickness in hypertensive left ventricular hypertrophy (LVH) has been shown by echocardiography to allow preserved shortening at the endocardium despite depressed LV midwall circumferential shortening (MWCS). Depressed MWCS is an adverse prognostic indicator, but whether this finding reflects reduced global or regional LV myocardial function, as assessed by three-dimensional (3D) myocardial strain, is unknown. Methods and Results: Cardiac Magnetic Resonance (CMR) tissue tagging permits direct evaluation of regional 3D intramyocardial strain, independent of LV geometry. We evaluated 21 hypertensive patients with electrocardiographic LVH in the LIFE study and 8 normal controls using 3D MR tagging and echocardiography. Patients had higher MR LV mass than normals (116 ± 40 versus 63 ± 6 g/m2, P = 0.002). Neither echocardiographic fractional shortening (32 ± 6 versus 33% ± 3%), LVEF (63% versus 64%) or mean end-systolic stress (175 ± 27 versus 146 ± 28 g/cm2) were significantly different, yet global MWCS was decreased by both echocardiography (13.4 ± 2.8 versus 18.2% ± 1.5%, P P P = 0.002) in LVH and greater in lateral and anterior regions versus septal and posterior regions ( P P P 0.60, P = 0.001 for both). Conclusions: In patients with hypertensive LVH, despite normal LV function via echocardiography or CMR, CMR intramyocardial tagging show depressed global MWCS while 3D MR strain revealed marked underlying regional heterogeneity of LV dysfunction.展开更多
1 Introduction Hypertension and cerebrovascular disease incidence and prevalence rise dramatically with age, owing to longer exposure time to age-associated alterations in vascular function and structure and cardiova...1 Introduction Hypertension and cerebrovascular disease incidence and prevalence rise dramatically with age, owing to longer exposure time to age-associated alterations in vascular function and structure and cardiovascular risk factors. This chapter is aimed at connecting age-related alterations in vascular function and structure to the resultant target organ damage, and to raise awareness of unique presentations and treatment strategies for hypertension and stroke in older adults.展开更多
Ghazi L, Dudenbostel T, Xing D, Ejem D, Turner-Henson A, Joiner CI, Affuso O, Azuero A, Oparil S, Calhoun DA, Rice M, Hage FG. Assessment of vascular function in low socioeconomic status preschool children： a pilot...Ghazi L, Dudenbostel T, Xing D, Ejem D, Turner-Henson A, Joiner CI, Affuso O, Azuero A, Oparil S, Calhoun DA, Rice M, Hage FG. Assessment of vascular function in low socioeconomic status preschool children： a pilot study. J Am Soc Hypertens ,2016 ： 1-9. 全球高血压患者〉10亿例，每年造成710万人死亡。在美国，〉8000万例成人及200万～300万例儿童患高血压。按当前趋势预计到2030年，美国高血压成年患者将增加2700万。越来越多的证据表明，包括高血压在内的心血管病危险因素在童年时期即出现并持续至成人后。因此，对日后可能出现心血管病高危因素的儿童，在早期予以干预十分重要。展开更多
2000年以前的数据显示,在美国大部分心血管事件均发生在血压≥140/90mm Hg（1mm Hg=0.133kPa）的成人身上。该研究旨在评估在3个当代美国队列的汇总分析中,血压〈140/90 mm Hg受试者心血管事件的发生率。这3个研究分别是脑卒中地理和种...2000年以前的数据显示,在美国大部分心血管事件均发生在血压≥140/90mm Hg（1mm Hg=0.133kPa）的成人身上。该研究旨在评估在3个当代美国队列的汇总分析中,血压〈140/90 mm Hg受试者心血管事件的发生率。这3个研究分别是脑卒中地理和种族差异原因（the reasons for geographic and racial differences in stroke,REGARDS）研究、展开更多
难治性高血压定义为尽管使用≥5种不同的抗高血压药物,包括氯噻酮和螺内酯,血压仍未得到控制。最近的研究表明,难治性高血压并不常见,仅5%-10%的患者因为血压得不到控制被转诊至高血压专科诊所。白大衣效应指的是自动诊室血压≥135/85mm...难治性高血压定义为尽管使用≥5种不同的抗高血压药物,包括氯噻酮和螺内酯,血压仍未得到控制。最近的研究表明,难治性高血压并不常见,仅5%-10%的患者因为血压得不到控制被转诊至高血压专科诊所。白大衣效应指的是自动诊室血压≥135/85mm Hg（1mm Hg=0.133kPa）,而诊室外清醒时动态血压监测血压〈135/85 mm Hg,占所有高血压患者的30%-40%。展开更多
先前研究表明降压治疗的依从性差会增加诊间血压变异性。该研究在降压和降脂治疗预防心脏病发作试验（antihypertensive and lipid-lowering treatment to prevent heart attack trial,ALLHAT）中评估降压治疗依从性与诊间血压变异性的...先前研究表明降压治疗的依从性差会增加诊间血压变异性。该研究在降压和降脂治疗预防心脏病发作试验（antihypertensive and lipid-lowering treatment to prevent heart attack trial,ALLHAT）中评估降压治疗依从性与诊间血压变异性的关系。展开更多
前瞻性研究表明,难治性高血压患者中有20%患醛固酮增多症。针对正常血压和高血压患者的观察性研究中,有少数研究发现醛固酮水平与肥胖之间存在相关性,但是其他研究未能证实该结论。先前尚未有研究阐明难治性高血压患者体质量指数（body ...前瞻性研究表明,难治性高血压患者中有20%患醛固酮增多症。针对正常血压和高血压患者的观察性研究中,有少数研究发现醛固酮水平与肥胖之间存在相关性,但是其他研究未能证实该结论。先前尚未有研究阐明难治性高血压患者体质量指数（body mass index,BMI）与醛固酮水平之间的相关性。展开更多
文摘Background: Increased relative wall thickness in hypertensive left ventricular hypertrophy (LVH) has been shown by echocardiography to allow preserved shortening at the endocardium despite depressed LV midwall circumferential shortening (MWCS). Depressed MWCS is an adverse prognostic indicator, but whether this finding reflects reduced global or regional LV myocardial function, as assessed by three-dimensional (3D) myocardial strain, is unknown. Methods and Results: Cardiac Magnetic Resonance (CMR) tissue tagging permits direct evaluation of regional 3D intramyocardial strain, independent of LV geometry. We evaluated 21 hypertensive patients with electrocardiographic LVH in the LIFE study and 8 normal controls using 3D MR tagging and echocardiography. Patients had higher MR LV mass than normals (116 ± 40 versus 63 ± 6 g/m2, P = 0.002). Neither echocardiographic fractional shortening (32 ± 6 versus 33% ± 3%), LVEF (63% versus 64%) or mean end-systolic stress (175 ± 27 versus 146 ± 28 g/cm2) were significantly different, yet global MWCS was decreased by both echocardiography (13.4 ± 2.8 versus 18.2% ± 1.5%, P P P = 0.002) in LVH and greater in lateral and anterior regions versus septal and posterior regions ( P P P 0.60, P = 0.001 for both). Conclusions: In patients with hypertensive LVH, despite normal LV function via echocardiography or CMR, CMR intramyocardial tagging show depressed global MWCS while 3D MR strain revealed marked underlying regional heterogeneity of LV dysfunction.
文摘1 Introduction Hypertension and cerebrovascular disease incidence and prevalence rise dramatically with age, owing to longer exposure time to age-associated alterations in vascular function and structure and cardiovascular risk factors. This chapter is aimed at connecting age-related alterations in vascular function and structure to the resultant target organ damage, and to raise awareness of unique presentations and treatment strategies for hypertension and stroke in older adults.
文摘Ghazi L, Dudenbostel T, Xing D, Ejem D, Turner-Henson A, Joiner CI, Affuso O, Azuero A, Oparil S, Calhoun DA, Rice M, Hage FG. Assessment of vascular function in low socioeconomic status preschool children： a pilot study. J Am Soc Hypertens ,2016 ： 1-9. 全球高血压患者〉10亿例，每年造成710万人死亡。在美国，〉8000万例成人及200万～300万例儿童患高血压。按当前趋势预计到2030年，美国高血压成年患者将增加2700万。越来越多的证据表明，包括高血压在内的心血管病危险因素在童年时期即出现并持续至成人后。因此，对日后可能出现心血管病高危因素的儿童，在早期予以干预十分重要。
文摘在收缩压干预试验(systolic blood pressure intervention trial, SPRINT)中,各治疗组的脑卒中发生比例差异无统计学意义,但脑卒中亚型的病因不同,可能对强化降压治疗的反应不同。SPRINT纳入患者(n=9 361)随机分为目标收缩压<120 mm Hg(1 mm Hg=0.133 kPa)的强化治疗与目标收缩压<140 mm Hg的标准治疗组。
文摘2000年以前的数据显示,在美国大部分心血管事件均发生在血压≥140/90mm Hg（1mm Hg=0.133kPa）的成人身上。该研究旨在评估在3个当代美国队列的汇总分析中,血压〈140/90 mm Hg受试者心血管事件的发生率。这3个研究分别是脑卒中地理和种族差异原因（the reasons for geographic and racial differences in stroke,REGARDS）研究、
文摘难治性高血压定义为尽管使用≥5种不同的抗高血压药物,包括氯噻酮和螺内酯,血压仍未得到控制。最近的研究表明,难治性高血压并不常见,仅5%-10%的患者因为血压得不到控制被转诊至高血压专科诊所。白大衣效应指的是自动诊室血压≥135/85mm Hg（1mm Hg=0.133kPa）,而诊室外清醒时动态血压监测血压〈135/85 mm Hg,占所有高血压患者的30%-40%。
文摘先前研究表明降压治疗的依从性差会增加诊间血压变异性。该研究在降压和降脂治疗预防心脏病发作试验（antihypertensive and lipid-lowering treatment to prevent heart attack trial,ALLHAT）中评估降压治疗依从性与诊间血压变异性的关系。
