高血压所致心肌肥厚综述

A Review of Myocardial Hypertrophy Caused by Hypertension

摘要: 高血压性心肌肥厚是高血压最常见且最重要的靶器官损害之一，也是连接持续性血压负荷与心力衰竭、心律失常及心血管死亡的重要病理环节。近年来，随着影像学、分子生物学和转化研究的进展，人们对高血压性心肌肥厚的认识已由单纯“左室壁增厚”拓展为涉及机械转导、神经体液激活、细胞信号异常、分子重编程、纤维化、代谢重构及微循环障碍的连续病理过程。与此同时，临床评估模式也由传统左室质量测量逐步转向几何构型、组织表征和功能损伤的综合识别，治疗目标亦由单纯降压延伸至逆转重构、延缓心衰进展和改善长期预后。本文围绕高血压性心肌肥厚的基础病理机制、病理形态学特征、临床评估与诊断、疾病进展、治疗与干预策略以及前沿与争议等方面进行综述，旨在为深入理解其发生发展机制、优化风险分层及探索精准干预路径提供参考。

Abstract: Hypertensive myocardial hypertrophy is one of the most common and important target organ damage in hypertension, and it is also an important pathological link connecting persistent blood pressure load with heart failure, arrhythmia and cardiovascular death. In recent years, with the progress of imaging, molecular biology and transformation research, people’s understanding of hypertensive myocardial hypertrophy has expanded from simple “left ventricular wall thickening” to a continuous pathological process involving mechanical transduction, neurohumoral activation, abnormal cell signal, molecular reprogramming, fibrosis, metabolic reconstruction and microcirculation disturbance. At the same time, the clinical evaluation mode has gradually shifted from the traditional left ventricular mass measurement to the comprehensive identification of geometric configuration, tissue characterization and functional injury, and the treatment goal has also extended from simple hypotension to reverse remodeling, delay the progress of heart failure and improve long-term prognosis. In this paper, the basic pathological mechanism, pathomorphological characteristics, clinical evaluation and diagnosis, disease progress, treatment and intervention strategies, frontier and controversy of hypertensive myocardial hypertrophy are reviewed, aiming at providing reference for further understanding its occurrence and development mechanism, optimizing risk stratification and exploring accurate intervention paths.