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Regression of structural alterations in hypertension
E Agabiti-Rosei1, M L Muiesan, G Muiesan
1Clinica Medica, University of Brescia, Italy.
Insights
Treating hypertension can lead to regression of cardiovascular changes. Further research is needed to determine if this regression improves patient outcomes independently of blood pressure reduction.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Biology
Background:
- Hypertension significantly increases morbidity and mortality, especially with existing cardiovascular complications.
- Regression of cardiovascular alterations in hypertensive patients is a key treatment goal.
- Cardiac hypertrophy and structural vascular changes are common in hypertension.
Purpose of the Study:
- To review the current understanding of cardiovascular structural changes in hypertension.
- To assess the potential for regression of these changes with antihypertensive treatments.
- To identify gaps in knowledge regarding the factors influencing regression and its prognostic significance.
Main Methods:
- Review of prospective epidemiological and clinical studies.
- Assessment of cardiac hypertrophy using echocardiography.
- Evaluation of structural vascular changes by measuring minimal vascular resistance.
Main Results:
- Several antihypertensive drugs can induce significant regression of cardiovascular structural changes.
- Complete normalization of these changes has not yet been definitively established.
- Factors modulating the regression of cardiac and vascular smooth muscle hypertrophy require further investigation.
Conclusions:
- While antihypertensive drugs promote regression of cardiovascular structural changes, complete normalization is uncertain.
- More research is necessary to identify factors influencing this regression.
- The independent prognostic value of cardiovascular structural regression in hypertension remains to be clarified.
Abstract:
Morbidity and mortality are higher in hypertensive patients who have already developed cardiovascular complications. Several prospective epidemiological and clinical studies have indicated that regression of cardiovascular alterations, preferably when still at an initial stage, is a desirable goal in the treatment of hypertension. Clinical assessment of cardiac hypertrophy may be precisely obtained with echocardiography. Structural vascular changes may be evaluated indirectly in man by measuring minimal vascular resistance from maximal blood flow and arterial pressure. The results of a large number of studies have indicated that in hypertensive patients a significant regression of cardiovascular structural changes may be obtained with several antihypertensive drugs, but they have not yet established whether a complete "normalization" may be really obtained. Further studies are needed to identify factors that modulate regression of cardiac and vascular smooth muscle hypertrophy. Most important, it still remains to be clarified whether regression of cardiovascular structural changes in hypertensives significantly improves prognosis per se independently from blood pressure reduction.