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Effects of antihypertensive therapy on hypertensive heart disease
F H Messerli1, U R Kaesser, C J Losem
1Department of Internal Medicine, Ochsner Clinic, New Orleans, LA 70121.
Insights
Left ventricular hypertrophy (LVH), often caused by hypertension, significantly increases cardiovascular disease risk. Antihypertensive medications like calcium channel blockers and ACE inhibitors can prevent or reverse LVH, improving patient outcomes.
Area of Science:
- Cardiology
- Hypertension Research
Background:
- Left ventricular hypertrophy (LVH) is a common consequence of essential hypertension.
- LVH is not merely adaptive; it elevates risks for sudden death, myocardial ischemia, and heart failure.
Purpose of the Study:
- To review the cardiovascular risks associated with LVH.
- To discuss the role of antihypertensive agents in managing LVH.
Main Methods:
- Literature review of studies on LVH and antihypertensive treatments.
- Comparative analysis of calcium channel blockers and angiotensin converting enzyme (ACE) inhibitors.
Main Results:
- LVH impairs ventricular filling and increases arrhythmia risk, independent of coronary artery disease.
- Calcium channel blockers and ACE inhibitors can prevent or reverse LVH.
- Calcium channel blockers excel at suppressing arrhythmias and improving compliance, while ACE inhibitors benefit patients with reduced contractility.
Conclusions:
- Tailored antihypertensive therapy using agents like calcium channel blockers and ACE inhibitors offers optimism for reducing cardiovascular morbidity and mortality in LVH patients.
Abstract:
Left ventricular hypertrophy (LVH) is a common sequela of long-standing essential hypertension. LVH cannot be considered, however, an adaptive process only serving to normalize wall stress but can be considered one that significantly increases the risk of sudden death, myocardial ischemia, congestive heart failure, and other cardiovascular diseases. Patients with LVH exhibit impaired ventricular filling, ventricular arrhythmias, and myocardial ischemia even in the absence of coronary artery disease. LVH can be prevented or reversed by a variety of antihypertensive agents including calcium channel blockers and angiotensin converting enzyme inhibitors. Calcium channel blockers, more than angiotensin converting enzyme (ACE) inhibitors, suppress ectopic impulse generation, improve ventricular compliance, and alleviate myocardial ischemia while preserving or improving the contractile state. In contrast, ACE inhibitors can be particularly useful in patients with LVH and diminished ventricular contractility and in preventing chamber dilatation after myocardial infarct. These favorable cardiovascular effects of both calcium channel blockers and ACE inhibitors are a reason for optimism that carefully tailored therapy will ultimately diminish the well-documented risk of cardiovascular morbidity and mortality associated with LVH.