Treatment of hypertensive heart disease with ACE inhibitors

Hypertensive left ventricular hypertrophy is associated with a variety of complications including congestive heart failure, arrhythmias, and ischemic heart disease. Unloading the system in time by antihypertensive drug treatment should prevent or reverse left ventricular hypertrophy. Although most antihypertensive agents can control blood pressure in a majority of patients, only a select subset of these pharmacologic agents will reverse left ventricular mass. There is evidence to suggest that angiotensin-converting enzyme (ACE) inhibitors can play an important role in protecting the heart during the various phases of evolution of hypertensive heart disease both acutely and on a long-term basis. Several studies in hypertensive humans and experimental animals have documented the effectiveness of ACE inhibitors in reducing cardiac hypertrophy. In hypertensive patients with left ventricular hypertrophy, the ACE inhibitor captopril 3 and 9 months after starting treatment significantly reduced left ventricular mass as well as left ventricular posterior wall and septal wall thickness. The mechanism of regression of left ventricular mass by ACE inhibition is speculative. The absence of a reflex hyperadrenergic state in the face of blood pressure control may be of importance. In addition, interference with angiotensin II generation by these agents may also play a role either through the myocardial effects of angiotensin II on protein synthesis or because of its facilitation of cardiac sympathetic neurotransmitter release. ACE inhibition appears to be associated with the maintenance of normal coronary flow reserve and in high renin states ACE inhibition may increase coronary blood flow. ACE inhibitors are also indicated under conditions of hypertensive heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)