[The primary and secondary prevention of hypertensive cardiopathy]

Antihypertensive treatment is useful in reducing cardiovascular morbidity and mortality. The possibility of preventing cardiac events is mainly related to the effect of antihypertensive drugs on the occurrence of hypertensive heart disease, i.e. on the anatomic and functional abnormalities of the left ventricle that represent the direct consequence of blood pressure increase. Hypertensive heart disease is associated with the concomitant occurrence of structural and functional changes in large arteries and small resistance arteries. Left ventricular hypertrophy represents the sign of preclinical disease in hypertensive heart disease. The use of antihypertensive treatment may induce the regression of left ventricular hypertrophy and determine a significant improvement of functional and clinical consequences of cardiac hypertrophy, and more importantly the regression of left ventricular hypertrophy is associated with an improvement of cardiovascular prognosis in hypertensive patients. It remains to be established whether some antihypertensive drugs are more effective, or only faster, in determining left ventricular hypertrophy regression. Antihypertensive treatment is extremely useful not only in the primary prevention of cardiac events and hypertrophy, but also in the reduction of cardiac complications in patients already presenting with cardiac disease; in fact these patients are at higher cardiovascular risk and therefore the benefit from blood pressure reduction may be even more evident.