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Regression of left ventricular hypertrophy: do antihypertensive classes differ?

D J Sheridan1

  • 1Division of NHLI, Imperial College School of Medicine, St Mary's Hospital, London, UK. d.sheridan@ic.ac.uk

Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension
|August 22, 2000
PubMed
Summary

Left ventricular hypertrophy (LVH) is a significant cardiac risk. While early studies suggested varying effectiveness of antihypertensive drugs, recent trials confirm ACE inhibitors and diuretics effectively regress LVH, improving prognosis.

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Area of Science:

  • Cardiology
  • Internal Medicine
  • Pharmacology

Background:

  • Left ventricular hypertrophy (LVH) is a major risk factor for cardiac morbidity and mortality, independent of coronary heart disease.
  • Understanding the mechanisms of LVH risk, including electrophysiology, coronary perfusion, and contractile function, is crucial.
  • Regression of LVH offers prognostic benefits, driving the search for optimal regression treatments.

Purpose of the Study:

  • To evaluate the effectiveness of different antihypertensive classes in achieving regression of left ventricular hypertrophy.
  • To compare findings from early studies with recent, well-designed clinical trials on LVH regression.
  • To assess the role of angiotensin-converting enzyme (ACE) inhibitors and diuretics in LVH regression.

Main Methods:

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  • Review of early studies and meta-analyses on antihypertensive therapy and LVH regression.
  • Analysis of results from recent prospective clinical trials, including TOMHS, VA study, and LIVE.
  • Consideration of echocardiographic measurements of left ventricular (LV) mass index.

    • Main Results:

    • Early studies may have overestimated LVH regression due to regression to the mean.
    • Meta-analyses of early studies suggested ACE inhibitors were most effective.
    • Recent large trials confirm ACE inhibitors and diuretics are effective in regressing LVH.

    Conclusions:

    • Antihypertensive therapy, particularly with ACE inhibitors and diuretics, can achieve regression of LVH.
    • Long-term studies are needed to confirm the prognostic benefits of LVH regression.
    • Future research should explore the reversal of underlying hypertrophy pathophysiology and LVH prevention.