Network Meta-analysis of oral blood-activating and stasis-removing Chinese patent medicines in treatment of hypertensive left ventricular hypertrophy / 中国中药杂志

This study was designed to assess the clinical efficacy of oral blood-activating and stasis-removing Chinese patent medicines in treating hypertensive left ventricular hypertrophy(LVH) based on network Meta-analysis. The clinical randomized controlled trials(RCTs) concerning the treatment of hypertensive LVH with oral blood-activating and stasis-removing Chinese patent medicines were retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, and Cochrane Library from their inception to September 2021. Two researchers independently completed the literature screening, data extraction, and quality evaluation. The data were then analyzed by RevMan 5.3, Stata 15.1, and ADDIS 1.16.8. Finally, a total of 31 RCTs were included, involving 3 001 patients and four oral blood-activating and stasis-removing Chinese patent medicines. In terms of the alleviation of heart damage, the Chinese patent medicines combined with conventional western medicine groups were superior to the conventional western medicine groups in lo-wering the left ventricular mass index(LVMI). There was no significant difference in LVMI, left ventricular ejection fraction(LVEF), or the ratio of early diastolic peak flow velocity to late diastolic peak flow velocity(E/A) between different Chinese patent medicines combined with conventional western medicine groups. Xinnao Shutong Capsules/Tablets combined with conventional western medicine had the best efficacy in reducing LVMI and elevating LVEF, while Xinkeshu Capsules/Tablets combined with conventional western medicine had the best effect in improving E/A. In the control of blood pressure, when all Chinese patent medicines except for Xinnao Shutong Capsules/Tablets were combined with conventional western medicine, the resulting systolic blood pressure(SBP) and diastolic blood pressure(DBP) were significantly lower than those in the conventional western medicine group. Xinkeshu Capsules/Tablets combined with conventional western medicine produced the best effect in reducing SBP and DBP, followed by Xinnao Shutong Capsules/Tablets. In terms of safety, no serious adverse reactions occurred in all trials. The four oral blood-activating and stasis-removing Chinese patent medicines included in this study exhibited obvious advantages in the treatment of hypertensive LVH when they were combined with conventional western medicine, with the best effects observed in the Xinnao Shutong Capsules/Tablets combined with conventional western medicine group. However, due to the limitation of the quantity and quality of the included articles, the conclusion of this study still needs to be verified by more high-quality, multi-center, and large-sample RCTs.

Influence of left ventricular hypertrophy on ventricular arrhythmias in hypertensive patients / 대한내과학회지

OBJECTIVES:Left ventricular hypertrophy(LVH) increases the risk of sudden death in hypertensive patients and this is known due to ventricular arrhythmias. Thus, author studied the relationship between LVH as a hypertensive target organ damage and ventricular arrhythmias. METHODS: 24-hour ambulatory electrocardiographic monitoring, measurement of microalbumin in 24-hour urine and fundoscopic examination were performed on 100 hypertensives (50 patients without LVH and 50 patients with LVH on EKG) who admitted Pusan National University Hospital. RESULTS: In patients with LVH, ventricular extrasystoles occurred more frequently than without LVH(p<0.05) and ventricular couplet and ventricular tachycardia were more common but statistically not different. Microalbuminuria and hypertensive retinopathy were more severe in patients with LVH than without LVH(p<0.05 and p<0.01, respectively). CONCLUSION: Of the ventricular arrhythmias, ventricular extrasystole but not ventricular couplet and ventricular tachycardia occurred more frequently in patients with LVH than without LVH. Thus, prospective study with long-term follow up should be done to establish the relationship between hypertensive LVH and cardiovascular mortality, especially sudden death. And, further study should be done to make the relationship between reduction in LVH with antihypertensive therapy and reduction in LVH-associated ventricular arrhythmias.

Normal Values of Left Ventricular Mass and Left Ventricular Mass Index and Criteria for Left Ventricular Hypertrophy by Echocardiography in Korean

BACKGROUND: Left Ventricular hypertrophy(LVH) is welll known independent predictors of cardiovascular morbidity and mortality. Recently echocardiography is popular method to measure Left Ventricular Mass(LVM) and detect LVH. The purpose of this study is to determine the mean values of LVM and criteria for LVH in Korean. METHODS: Two hundered and fifty five subjects who participate in the health clinic were selected and studied(among them, 47 subjects were excluded according to exclusion criteria). History, physical examination, routine laboratories, and echocardiography were performed ot all of the subjects. RESULTS: The mean values of LVM, LVM corrected for body surface area(BSA), and LVM corrected for height are respectively : 199g, 114g/m2, and 119g/m in 119 Korean men, and 168g, 107g/m2, and 108g/m in 89 women, by echocardiography in accordance with the American Society of Echocardiography(ASE) convention. The criteria for LVH, based on mean plus two standard deviation for LVM, LVM/BSA, and LVM/height are, respectively : 301g, 168g/m2, and 181g/m in men, and 262g, 165g/m2, and 168g/m in women. CONCLUSIONS: The prevalence of LV hypertrophy in the evtire study group using LV mass/surface criteria and LV mass/height are respectively 7.6% in men and 10.9% in women and 6.9% in men and 10% in women. There are little difference of the prevalance rate of LV Hypertrophy by whichever criteria were used, either based on LVM/body surface or LVM/height while still correcting for body size.