An updated concept for left ventricular hypertrophy risk in hypertension
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1Division of Research, Ochsner Clinic Foundation, New Orleans, LA.
Insights
Left ventricular hypertrophy (LVH) is a risk factor for heart disease. Current antihypertensive therapies can reduce LVH and associated risks by addressing factors like fibrosis and inflammation.
Area of Science:
- Cardiology
- Hypertension Research
- Risk Factor Analysis
Background:
- Left ventricular hypertrophy (LVH) is a primary risk factor for coronary heart disease morbidity and mortality, identified by the Framingham Heart Study.
- Antihypertensive agents were early interventions to reduce left ventricular (LV) mass and arterial pressure.
- Regulatory approval for LVH risk reduction is pending, despite all antihypertensive drugs reducing LV mass.
Purpose of the Study:
- To review current knowledge on risk factors associated with LVH.
- To explore newer diagnostic methods for LVH-related epiphenomena.
- To outline a contemporary treatment paradigm for hypertension and LVH risk reduction.
Main Methods:
- Review of existing literature on left ventricular hypertrophy and antihypertensive therapy.
- Analysis of emerging research on specific risk epiphenomena (ischemia, fibrosis, apoptosis, salt, inflammation).
- Evaluation of current clinical practices and diagnostic advancements.
Main Results:
- All antihypertensive drugs decrease LV mass; however, specific risk reduction indications are not approved.
- Investigative efforts have identified ischemia, fibrosis, apoptosis, dietary salt, and inflammation as key risk factors.
- Newer diagnostic tools are available to detect these specific alterations.
- Current therapies can improve coronary blood flow, reduce fibrosis and apoptosis, and mitigate salt intake and potentially inflammation.
Conclusions:
- Existing knowledge supports a paradigm shift in hypertension management to specifically target LVH risk reduction.
- Comprehensive treatment should address factors like fibrosis, apoptosis, and dietary salt.
- Further research is needed, particularly on the role of inflammatory factors in LVH.
Abstract:
Left ventricular hypertrophy (LVH) was one of the first three "factors of risk" originally identified by the Framingham Heart Study predisposing the patient to premature morbidity and mortality resulting from coronary heart disease. Among the initial approaches toward specific risk reduction were antihypertensive agents that reduce left ventricular (LV) mass with control of arterial pressure. However, the indication to reduce risk from LVH has not been approved by the federal regulatory agency. All drugs that reduce arterial pressure are capable of decreasing LV mass. More recently, investigative efforts in the laboratory and clinic have focused on identifying specific epiphenomena that are responsible for risk; they include ischemia, fibrosis, apoptosis, dietary salt excess, and inflammatory factors. Newer clinical methods are becoming available to diagnose these alterations. Current antihypertensive therapy and management improve coronary blood flow and flow reserve, diminish ventricular fibrosis and apoptosis, employ established educational interventions to reduce dietary salt intake, and may prevent inflammatory factors (although the latter factor requires further study; and others, no doubt, will continue to be identified). Thus, present knowledge is available to apply this more current paradigm for the treatment of hypertension and to reduce risk from LVH.
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