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[Hypertrophy of left ventricular myocardium as modifiable risk factor: novel possibilities of correction]

O S Bulkina, K A Talitskiĭ, Iu A Karpov

    Kardiologiia
    |May 20, 2006
    PubMed

    Insights

    Left ventricular hypertrophy (LVH) in hypertension increases complication risks. Combined ACEI and diuretic therapy, like perindopril/indapamide, effectively reduces LVH and cardiovascular risk.

    Area of Science:

    • Cardiology
    • Hypertension Research
    • Pharmacology

    Context:

    • Arterial hypertension affects 15-20% of patients, often leading to left ventricular hypertrophy (LVH).
    • LVH is an independent risk factor for severe hypertension complications, including ischemic heart disease, heart failure, and arrhythmias.
    • Regression of LVH during antihypertensive treatment significantly lowers cardiovascular risk.

    Purpose:

    • To evaluate the efficacy of different antihypertensive strategies in managing left ventricular hypertrophy (LVH) in patients with arterial hypertension.
    • To compare the LVH regression effects of combined therapy (ACEI + diuretic) versus ACEI monotherapy.
    • To determine the optimal therapeutic approach for hypertensive patients with LVH.

    Summary:

    • The PIXEL trial demonstrated that a fixed combination of perindopril (ACEI) and indapamide (diuretic) reduced LVH more effectively than high-dose enalapril (ACEI) monotherapy.
    • This combination also provided superior blood pressure control compared to enalapril monotherapy.
    • Angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) show significant potential for reversing LVH.

    Impact:

    • Combined therapy with ACEI and diuretics, including fixed-dose combinations, is recommended as a treatment of choice for hypertension with LVH.
    • This approach offers enhanced cardiovascular risk reduction beyond blood pressure control alone.
    • Optimizing LVH regression is crucial for improving long-term outcomes in hypertensive patients.

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