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[Antihypertensive treatment and remission of left ventricular hypertrophy. Critical study]
J Clémenty1, M N Dulhoste, P Bordier
1Service de cardiologie, hôpital Cardiologique, université de Bordeaux, Pessac.
Insights
Left ventricular hypertrophy (LVH) can be a cardiovascular risk, but some antihypertensive drugs effectively reduce it. Early hypertension treatment may prevent LVH development.
Area of Science:
- Cardiology
- Hypertension research
- Cardiac remodeling
Context:
- Left ventricular hypertrophy (LVH) is an adaptive cardiac response to hypertension.
- LVH can become an independent cardiovascular risk factor.
- Regression of LVH is a key goal in antihypertensive therapy.
Purpose:
- To evaluate the impact of antihypertensive drugs on LVH regression.
- To discuss challenges in measuring and interpreting LVH regression.
- To assess the cardiovascular benefits of LVH regression.
Summary:
- Certain antihypertensive medications (methyldopa, beta-blockers, ACE inhibitors, calcium antagonists) promote early and sustained LVH regression.
- Diuretics offer minimal or debatable reduction in myocardial mass.
- Vasodilators show little to no effect on LVH regression.
- Reliability of measurement methods, inter-drug variations, and the clinical benefit of LVH regression require further investigation.
- Recent trials suggest early hypertension management can prevent LVH development.
Impact:
- Understanding drug efficacy in LVH regression guides treatment strategies.
- Highlights the importance of addressing cardiac remodeling in hypertensive patients.
- Emphasizes the potential of early intervention to mitigate cardiovascular complications associated with hypertension.
Abstract:
Left ventricular hypertrophy which is the adaptive mechanism of the heart to hypertension may become a cardiovascular risk factor independent of the hypertension which induced it: the regression of left ventricular hypertrophy therefore constitutes one of the medium-term objectives of antihypertensive therapy. Some antihypertensive drugs make the left ventricular hypertrophy regress early and permanently: methyldopa, betablockers, converting enzyme inhibitors, calcium antagonists. The reduction of myocardial mass is slight or debatable with diuretics and absent or inconstant with vasodilator therapy. The regression of left ventricular hypertrophy in hypertension raises several problems: the reliability of methods of measurement; inter-individual and inter-drug variations; the beneficial nature of this regression; the preventive effect of regression of left ventricular hypertrophy on cardiovascular complications. In the light of recent trials, early treatment of hypertension may prevent the development of left ventricular hypertrophy.