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Regression of left ventricular hypertrophy: hoping for a longer life
1International Centre for Circulatory Health, St Mary's Hospital and Imperial College, London, W2 1NY, UK.
Insights
Left ventricular hypertrophy (LVH) is a significant predictor of poor prognosis, independent of blood pressure. Targeting LVH, potentially with renin-angiotensin-aldosterone system blockers, is crucial for better patient outcomes beyond blood pressure control.
Area of Science:
- Cardiology
- Hypertension Research
- Pharmacology
Background:
- Left ventricular hypertrophy (LVH) is an adaptive cardiac response to hypertension.
- LVH independently predicts poor prognosis, irrespective of blood pressure (BP) levels.
- Evidence suggests LVH should be a primary treatment target, beyond BP control.
Purpose of the Study:
- To evaluate the significance of LVH as a prognostic indicator in hypertension.
- To explore the role of renin-angiotensin-aldosterone system (RAAS) inhibitors in LVH regression.
- To discuss optimal antihypertensive treatment strategies considering LVH.
Main Methods:
- Review of evidence from major clinical trials like HOPE and LIFE.
- Analysis of drug mechanisms, particularly RAAS blockers, in LVH regression.
- Discussion of combination antihypertensive therapy for achieving BP goals.
Main Results:
- LVH is a critical factor influencing patient outcomes in hypertension.
- RAAS-blocking agents may induce greater LVH regression compared to other drug classes.
- The LIFE study indicated potential superiority of losartan over atenolol, possibly due to LVH effects.
Conclusions:
- Treating LVH is essential for improving prognosis in hypertensive patients.
- RAAS inhibitors are likely effective in regressing LVH.
- Achieving stringent BP goals, often requiring combination therapy, is paramount and may lead to LVH regression.
Abstract:
Left ventricular hypertrophy (LVH) is more than just an adaptive response to hypertension. It predicts a poor prognosis independently of the blood pressure (BP) level. There is increasing evidence from studies such as Heart Outcomes Prevention Evaluation (HOPE) and Losartan Intervention For Endpoint reduction in hypertension (LIFE) that LVH should be a target for treatment, above and beyond BP control. It is likely that drugs blocking the renin-angiotensin-aldosterone system cause greater regression of LVH than other agents and this is probably the mechanism that explains the superiority of losartan over atenolol in the LIFE study. In order to achieve the stringent BP goals suggested by modern guidelines, most patients will require multiple antihypertensive agents and the clinical choices relate more often to which combinations of drugs are most appropriate, rather than which single drug is the best. Tight BP control should be the first priority and this is likely to lead to regression of LVH.