[Regression of left heart hypertrophy in arterial hypertension: principles, experimental and clinical findings]

Left ventricular hypertrophy is the consequence of a structural adaptation of the heart in response to the chronic pressure load, leading to a reduction of the increased systolic wall stress. Studies in spontaneously hypertensive rats have shown, that left ventricular hypertrophy can be influenced by various, but not all antihypertensive agents. Alpha-methyldopa, captopril, beta-blockers and calcium channel blockers resulted in reversal of hypertrophy. Treatment with diuretics, hydralazine or minoxidil did not increase or alter degree of myocardial hypertrophy despite normalization of blood pressure. The biochemical profile after reversal of hypertrophy differs according to antihypertensive therapy, i.e. alpha-methyldopa induces an increase in collagen content, whereas captopril does not alter the collagen content of the myocardium. Adrenergic factors play an important role in modulating the response of the heart. In clinical studies the reduction in cardiac mass does not depend solely on the antihypertensive effect on blood pressure levels. There is only a weak correlation between decrease of left ventricular hypertrophy and fall of blood pressure level, as is shown in 12 patients with essential hypertension, treated with captopril over 6 months. The degree of regression of hypertrophy is influenced by stability of blood pressure control (diurnal variations and response to stress are more important than single casual values), neurohumoral response, presence of associated cardiac diseases, cause and severity of hypertension, genetic factors and age. We studied the regression of left ventricular hypertrophy by M-mode-echocardiography in 12 patients with mild or moderate essential hypertension during a 6-month therapy with captopril (50-75 mg p.d.) and hydrochlorothiazide (50 mg p.d.). In 11 of 12 patients captopril treatment resulted in a reduction of LV-mass of 30.9 +/- 15.1% and wall thickness. Peak systolic and endsystolic wall stress decreased significantly (-29.1% and -27.2%, resp.) after blood pressure reduction, but were still slightly elevated. Ejection fraction increased by 5.4% (p less than or equal to 0.05). 6 hypertensive patients treated for 6 months with metoprolol (150 mg p.d.) and hydrochlorothiazide (50 mg p.d.) do not show significant reduction of LV-mass (-6.5%). Peak and endsystolic wall stress were significantly reduced (-33.1% and -11.5%, resp.) as in captopril therapy. In 34 patients with severe hypertension treated with captopril, hydrochlorothiazide and metoprolol over 30 months, we observed a decline in the Sokolow-Lyon-Index from 4.8 +/- 1.1 mV to 3.8 +/- 0.5 mV after 6 months.(ABSTRACT TRUNCATED AT 400 WORDS)