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Long-term treatment in arterial hypertension for protecting hypertrophic myocardium
1Medizinische Klinik und Poliklinik B, Heinrich-Heine-Universität Düsseldorf, FRG.
Insights
Arterial hypertension causes cardiac complications like left-ventricular hypertrophy and coronary artery disease. Effective antihypertensive drugs can reverse these changes, improving heart function and reducing risks in hypertensive patients.
Area of Science:
- Cardiology
- Hypertension Research
- Cardiovascular Medicine
Background:
- Arterial hypertension leads to cardiac complications including left-ventricular hypertrophy, fibrosis, and coronary artery disease.
- These manifestations significantly impact left-ventricular function, ischemic risk, and arrhythmias in hypertensive individuals.
- Cardiac complications are major determinants of prognosis in arterial hypertension.
Purpose of the Study:
- To investigate the potential for reversing cardiac organ manifestations of arterial hypertension through therapeutic interventions.
- To assess the impact of antihypertensive therapy on myocardial hypertrophy, diastolic function, and coronary microangiopathy.
- To evaluate the effect of treatment on coronary reserve and ischemic risk in hypertensive heart disease.
Main Methods:
- Review of existing literature on the cardiac effects of arterial hypertension and its treatment.
- Analysis of the impact of antihypertensive drugs (dihydropyridine calcium channel blockers, ACE inhibitors, sympatholytics) on cardiac structure and function.
- Evaluation of changes in left-ventricular systolic and diastolic function, myocardial hypertrophy, and coronary microangiopathy.
Main Results:
- Antihypertensive drugs can induce regression of myocardial hypertrophy.
- Diastolic dysfunction is an early manifestation of hypertensive heart disease, with some aspects improving after treatment.
- Preliminary evidence suggests reversal of hypertensive coronary microangiopathy with improved coronary reserve and reduced ischemic risk.
Conclusions:
- Therapeutic reversal of myocardial hypertrophy and coronary microangiopathy are key goals in managing hypertensive heart disease.
- Antihypertensive therapy shows promise in improving cardiac function and reducing risks associated with hypertension.
- Further research is needed to determine the extent to which reversing these cardiac changes improves the overall prognosis of hypertensive heart disease.
Abstract:
The cardiac organ manifestation of arterial hypertension comprises the myocardium itself with left-ventricular hypertrophy, the interstitium with perivascular and interstitial fibrosis, and the coronary circulation with disease of large and small coronary arteries. The consequences of the sum and interactions of these cardiac organ manifestations have an impact on left-ventricular systolic and diastolic function, the ischemic risk, and the occurrence of arrhythmias in hypertensive patients. As the prognosis of arterial hypertension is determined, to a considerable extent, by these cardiac complications, the aim of treatment of hypertensive heart disease is reversal of the myocardial hypertrophy in order to prevent later progression to hypertensive failure. A further goal of therapy is reversal of hypertensive coronary microangiopathy in order to improve the coronary reserve and to reduce the ischemic risk. Regression of hypertrophy can be induced by suitable antihypertensive drugs (calcium channel blockers of the dihydropyridine type, ACE inhibitors, and sympatholytic substances). While normal systolic function was maintained in the compensated stage of hypertensive hypertrophy and was not significantly influenced by antihypertensive therapy, diastolic function was impaired in a very early stage of arterial hypertension. Both the phase of isovolumic relaxation and the phase of early diastolic filling were imparied, while after long-term antihypertensive treatment with Ca-channel blockers of the dihydropyridine type or ACE inhibitors, only the latter one was improved. From preliminary results there is clinical evidence that hypertensive disease of small coronary arteries can be reversed after long-term antihypertensive treatment with a consequently improved coronary reserve and a reduced ischemic risk. Moreover, to what extent the prognosis of hypertensive heart disease can be improved by reversal of myocardial hypertrophy and disease of small coronary arteries is yet unknown.