The Therapeutic Implications of Left Ventricular Hypertrophy in the Hypertensive Patient

Hypertension can be considered a syndrome broader than the condition of an increased blood pressure per se. Epidemiologic studies have established that high blood pressure is associated with an increased risk of cardiovascular events. Clinical trials of antihypertensive therapy have failed to show a consistent reduction in cardiovascular endpoints. The incidence of coronary disease has been reduced minimally, suggesting that factors beyond just measuring mm Hg in the hypertensive may be important in the genesis of atherosclerotic disease in hypertensive patients. Patients with hypertension appear to have an exaggerated vulnerability to the consequences of lipid abnormalities. In addition, hypertension is associated with insulin resistance and altered glucose tolerance. The increased plasma concentrations of insulin may produce proliferative effects on vascular smooth muscle and connective tissue, and these changes may adversely affect vascular integrity, leading to hypertrophy and facilitation of the arthersclerosis process. The left ventricle also appears to be involved in hypertension and this involvement may be independent of blood pressure. An increase in the muscle mass of the left ventricle as well as changes in its diastolic-filling characteristics occur early on with hypertension and may contribute to an adverse cardiovascular outcome. The arterial circulation is also involved. Alterations in structure or function of the vascular tree are reflected in diminished arterial compliance. These changes can be demonstrated prior to the appearance of clinical manifest hypertension. Based on these observations, treatment designed to reduce cardiovascular risk in hypertensive patients from cardiovascular events must not be based on blood pressure reduction alone but must take into account all the components of the hypertension syndrome.