Myocardial remodeling in hypertension.

Area of Science:

• Cardiology
• Physiology
• Hypertension Research

Background:

• Left ventricular (LV) hypertrophy and remodeling are common in hypertension, influenced by multiple factors beyond blood pressure.
• Traditional views suggested LV hypertrophy is an adaptive response to hypertension, preventing heart failure.
• Recent evidence challenges this, indicating LV hypertrophy may not be adaptive and is linked to adverse outcomes.

Purpose of the Study:

• To review the current understanding of left ventricular (LV) hypertrophy in hypertension.
• To challenge the traditional view of LV hypertrophy as a solely adaptive response.
• To explore the complex factors influencing LV remodeling and its association with cardiovascular outcomes.

Main Methods:

• Literature review and synthesis of existing research on hypertensive cardiovascular remodeling.
• Analysis of studies investigating LV geometric patterns and their clinical significance.
• Examination of experimental evidence regarding cardiomyocyte hypertrophy and cardiac function.

Main Results:

• Concentric hypertrophy is not the most frequent geometric pattern in hypertensive subjects; eccentric hypertrophy is more common.
• The transition from LV hypertrophy to dilation and systolic dysfunction is less common than previously thought, especially without coronary heart disease.
• LV hypertrophy is consistently associated with increased cardiovascular morbidity and mortality, questioning its adaptive role.

Conclusions:

• Left ventricular hypertrophy in hypertension is a complex phenotype, not necessarily an adaptive response.
• Factors like ethnicity, gender, salt intake, obesity, diabetes, and genetics modulate LV remodeling.
• The hypertrophic myocardium exhibits detrimental changes (fibrosis, apoptosis) predicting adverse cardiovascular outcomes.