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Optimal antihypertensive therapy for prevention and treatment of left ventricular hypertrophy
1Section of Cardiology, Department of Medicine, Rush Medical College, 1653 West Congress Parkway, Chicago, IL 60612, USA. pliebson@rush.edu
Insights
Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular events in hypertensive patients. While all first-line agents can regress LVH, their comparative efficacy in reducing cardiovascular risk independently of blood pressure remains unproven.
Area of Science:
- Cardiology
- Hypertension Research
- Internal Medicine
Background:
- Left ventricular hypertrophy (LVH) is a common adaptation to pressure overload in hypertensive patients.
- LVH is a significant independent risk factor for cardiovascular events, exceeding the risk associated with blood pressure alone.
- Current hypertension guidelines recommend stricter blood pressure control in patients with LVH.
Purpose of the Study:
- To review the current understanding of left ventricular hypertrophy in hypertension.
- To evaluate the role of antihypertensive agents in regressing LVH.
- To discuss the implications of LVH regression on cardiovascular prognosis.
Main Methods:
- Literature review of studies on left ventricular hypertrophy and hypertension.
- Analysis of evidence regarding the efficacy of first-line antihypertensive agents on LVH regression.
- Evaluation of prognostic data linking LVH regression to cardiovascular outcomes.
Main Results:
- All major classes of antihypertensive agents demonstrate some capacity to regress LVH.
- No definitive evidence currently establishes the superiority of one antihypertensive agent over others in reducing cardiovascular risk independent of blood pressure control.
- Evidence suggests LVH regression may be associated with improved prognosis, but comparative drug efficacy in this regard is not yet demonstrated.
Conclusions:
- Optimal antihypertensive therapy for patients with LVH should consider individual patient conditions.
- Major antihypertensive drug classes are expected to reduce LVH.
- Further research is needed to determine the relative efficacy of different drug classes in improving prognosis through LVH regression.
Abstract:
Left ventricular hypertrophy (LVH) is considered an adaptation to a pressure load on the left ventricle and is common in hypertensive patients. The condition is a profound risk factor for cardiovascular events, greater than and independent of blood pressure. It is now recognized in hypertension management guidelines as an indication for more stringent blood pressure control. All of the first-line antihypertensive agents have been shown to variably regress LVH, but no definitive evidence yet shows that one agent is superior to others in decreasing risk independent of blood pressure control. Although some evidence suggests that reduction of LVH is associated with improved prognosis independent of blood pressure control, relative efficacy of drug classes in this regard has yet to be demonstrated. At present, recommendations for optimal therapy in hypertensive patients with LVH must rest on the presence of underlying cardiac and noncardiac conditions, with the understanding that the major classes of antihypertensive agents will probably decrease LVH.