目的·通过分析原发性高血压患者左心室质量指数（left ventricular mass index，LVMI）的影响因素，探讨血醛固酮水平与左心室肥厚（left ventricular hypertrophy，LVH）的关系。方法·纳入2013年1月—2019年12月在上海交通大学医学院瑞金医院北部院区高血压科住院并经盐水负荷试验排除原发性醛固酮增多症的155例原发性高血压患者（盐水抑制后血浆醛固酮<60 pg/mL）。采集患者的一般临床资料（年龄、性别、吸烟情况、高血压病程等），体格检查结果（血压、体质量指数），血生化（肾功能、电解质、空腹血糖、血脂）、尿钠和相关激素（血浆基础及激发醛固酮、血浆基础及激发肾素、尿醛固酮、盐水抑制后血浆醛固酮等）水平，通过心脏超声评估LVMI。采用Pearson相关分析量化LVMI与各变量的线性关联，通过二元Logistic回归模型筛选LVH的独立危险因素，应用多元线性回归模型评估各变量对LVMI的影响。结果·155例原发性高血压患者平均年龄（46.85±11.08）岁，男性占51.6%。Pearson相关分析显示，LVMI与盐水抑制后血浆醛固酮（r=0.334，P<0.001）、年龄（r=0.184，P=0.032）、高血压病程（r=0.241，P=0.005）、收缩压（r=0.280，P=0.001）、脉压（r=0.339，P<0.001）具有相关性，而与舒张压、体质量指数、空腹血糖、总胆固醇、低密度脂蛋白胆固醇、甘油三酯、高密度脂蛋白胆固醇、尿钠、基础醛固酮、激发醛固酮及尿醛固酮无相关性；校正性别、吸烟史、年龄、高血压病程、体质量指数、脉压、收缩压、空腹血糖、总胆固醇等混杂因素后，二元Logistic回归表明，盐水抑制后血浆醛固酮水平每升高1 pg/mL，LVH风险增加5.1%（OR=1.051，95%CI 1.016~1.088，P=0.004）；多元线性回归显示盐水抑制后血浆醛固酮（β=0.359，P<0.001）、高血压病程（β=0.168，P=0.046）、脉压（β=0.226，P=0.008）是LVMI的独立影响因素。结论·盐水抑制后血浆醛固酮水平是原发性高血压患者LVH的独立影响因素。

Objective ·To analyze the influencing factors of left ventricular mass index (LVMI) in patients with essential hypertension, and explore the relationship between aldosterone levels and left ventricular hypertrophy (LVH). Methods ·A total of 155 patients with essential hypertension, hospitalized in the Hypertension Department of the Northern Campus of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from January 2013 to December 2019, and excluded from primary aldosteronism by saline load test (post-saline suppression plasma aldosterone <60 pg/mL), were enrolled. General clinical data (age, gender, smoking status, duration of hypertension, etc.), physical examination data (blood pressure and body mass index), blood biochemistry (renal function, electrolytes, fasting blood glucose, and lipids), urinary sodium, and relevant hormones (basal and activated aldosterone, basal and activated renin, urinary aldosterone, post-saline suppression aldosterone, etc.) were collected. LVMI was evaluated by echocardiography. Pearson correlation analysis was used to assess the linear association between LVMI and each variable. Binary Logistic regression models were applied to screen independent risk factors for LVH. Multiple linear regression models were used to assess the impact of variables on LVMI. Results ·The mean age of the 155 patients was (46.85±11.08) years, with 51.6% being male. Pearson correlation analysis showed that LVMI was significantly positively correlated with post-saline suppression aldosterone (r=0.334, P<0.001), age (r=0.184, P=0.032), duration of hypertension (r=0.241, P=0.005), systolic blood pressure (r=0.280, P=0.001), and pulse pressure (r=0.339, P<0.001). No significant correlations were found with diastolic blood pressure, body mass index, fasting blood glucose, total cholesterol, low-density lipoprotein cholesterol, triglyceride, high-density lipoprotein cholesterol, urinary sodium, basal aldosterone, activated aldosterone, or urinary aldosterone. After adjusting for confounders, including gender, smoking history, age, duration of hypertension, body mass index, pulse pressure, systolic blood pressure, fasting blood glucose, and total cholesterol, binary Logistic regression showed that each 1 pg/mL increase in post-saline suppression aldosterone was associated with a 5.1% increased risk of LVH (OR=1.051, 95%CI 1.016‒1.088, P=0.004). Multiple linear regression identified suppressed aldosterone (β=0.359, P<0.001), duration of hypertension (β=0.168, P=0.046), and pulse pressure (β=0.226, P=0.008) as independent influencing factors for LVMI. Conclusion ·Suppressed aldosterone is an independent influencing factor for LVH in patients with essential hypertension.