高血压在射血分数保留的心力衰竭发展中的作用

Role of Hypertension in Development of Heart Failure with Preserved Ejection Fraction

射血分数保留的心力衰竭目前依然有很多问题尚未解决,例如未能形成公认的定义和治疗方法等。大多数射血分数保留的心力衰竭患者存在动脉性高血压,目前尚不清楚其是否是导致射血分数保留的心力衰竭发展的必要条件。高血压和射血分数保留的心力衰竭的潜在发病机制涉及相同的生物系统:肾素-血管紧张素-醛固酮系统、交感神经系统和氧化应激反应。并非所有高血压患者都有射血分数保留的心力衰竭,但其中一些高血压患者具有发展为射血分数保留的心力衰竭的倾向性。对于射血分数保留的心力衰竭患者大型随机对照试验未证实肾素-血管紧张素-醛固酮系统抑制剂、利尿剂、钙通道阻滞剂和β受体阻滞剂的治疗有效性,即大多数研究未能证明射血分数保留的心力衰竭患者用药后全因死亡率降低,这些研究的主要局限性之一是射血分数保留的心力衰竭定义的不一致性,指在不同研究中左心室射血分数截断值介于40%～50%。这篇综述文章提供了关于高血压和射血分数保留的心力衰竭之间的病理生理学和机制,以及在这两种情况下调查和治疗的有价值数据。

Heart failure with preserved ejection fraction(HFpEF) is an entity that still raises many questions. The agreement about definition,pathophysiology,and therapeutic approach is still missing. Arterial hypertension is present in majority of patients with HFpEF,and it is still not clear if it represent a risk factor or necessary condition for HFpEF development. The underlying mechanisms of hypertension and HFpEF involve the same biological systems: renin-angiotensin-aldosteronesystem,sympathetic nervous system and oxidative stress.However,not all the hypertensive patients have HFpEF. The predisposition of some hypertensive patients to develop HFpEF needs to be resolved. Large randomized controlled trials did not prove the therapeutic effectiveness of renin-angiotensin-aldosterone inhibitors,diuretics,calcium channel blockers,and beta-receptor blockers in HFpEF patients. The majority of studies did not succeed to demonstrate the reduction of all-cause mortality in HFpEF individuals. One of the major limitations in these investigations was the inconsistency of HFpEF definition,which mainly refers to left ventricular ejection fraction cut-off that ranged from 40% to 50% in different studies. This review provides the available data about pathophysiology and mechanisms that connect hypertension and HFpEF,investigations and therapy used in both conditions.