Systolic and diastolic function following regression of left ventricular hypertrophy in hypertension

Echocardiography has demonstrated that regression of left ventricular hypertrophy (LVH) can occur following control of blood pressure, although the role of individual drugs in promoting this regression remains less clear. Since LVH in hypertension is an adaptive response to the increased afterload, and therefore serves to normalize wall stress, it is important to establish the effects of hypertrophy regression on cardiac function. Assessment of these effects, however, is complicated by the contributions of alteration in loading conditions and drug therapy to left ventricular function. Since systolic function is normal in LVH, it is not surprising that regression leads to no significant change in commonly measured indices of contractile function. Abnormalities of diastolic function, on the other hand, occur as a consequence of both hypertension and LVH, and reversal of these abnormalities might, therefore, be expected to lead to an improvement in diastolic function. This is indeed the case, although not in all reported studies. Only recently has information emerged on the effects of regression of LVH on function when blood pressure is allowed to return to its pretreatment level following discontinuation of antihypertensive therapy. Such trials, although requiring careful monitoring, are the only way of providing information on the effects of regression itself on left ventricular function. The implications of LVH regression and its attendant changes in function remain to be determined.