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Heart and vessel hypertrophy in hypertension: possibilities of regression
R Cífková1, P Niederle, L Romanovská
1Institute for Postgraduate Medical Education, Department of Cardiology, Prague, Czechoslovakia.
Insights
Blood pressure and left ventricular hypertrophy significantly decreased in hypertensive males treated with beta-blockers or methyldopa. Complete regression of left ventricular hypertrophy occurred in over half of the patients within two years.
Area of Science:
- Cardiology
- Hypertension Research
- Medical Imaging
Background:
- Left ventricular hypertrophy (LVH) is a common complication in middle-aged males with hypertension.
- Echocardiography is a key diagnostic tool for assessing LVH.
- Understanding the regression patterns of LVH is crucial for managing hypertensive heart disease.
Purpose of the Study:
- To investigate the effects of antihypertensive treatments on left ventricular hypertrophy regression.
- To determine the time course of LVH regression in response to therapy.
- To explore factors influencing the extent of LVH regression.
Main Methods:
- Fifty-two middle-aged hypertensive males with LVH were enrolled.
- Patients were treated with either beta-blockers or methyldopa, with add-on therapy as needed.
- Echocardiography was used to monitor changes in left ventricular structure over a 2-year follow-up period.
Main Results:
- Significant decreases in blood pressure and LVH (posterior wall and interventricular septal thickness) were observed, primarily within the first 3 months.
- Complete regression of LVH was achieved in 51.9% of patients.
- Incomplete regression was associated with higher initial LVH severity and obesity.
Conclusions:
- Antihypertensive therapy, including beta-blockers and methyldopa, can effectively reverse left ventricular hypertrophy in hypertensive males.
- The regression of LVH is a gradual process, with significant changes occurring early in treatment.
- While LVH regression did not impair left ventricular function, factors like obesity and initial hypertrophy severity influence treatment outcomes.
Abstract:
Fifty-two middle-aged hypertensive males with left ventricular hypertrophy, diagnosed by echocardiography, were divided into two groups; 30 of them were treated with beta-blockers and 22 with methyldopa. Where blood pressure was insufficiently controlled, diuretics and, eventually vasodilating agents, were added to both treatment regimes. During 2 years of follow-up, blood pressure decreased significantly. The greatest decrease was observed during the first 3 months. Echocardiography revealed the greatest decrease in posterior wall and interventricular septal thickness also during the first 3 months. Posterior wall hypertrophy was reversed completely in the next 3 months, while further regression of interventricular septal hypertrophy was continuous during the remaining follow-up period. Left ventricular hypertrophy was reversed completely in 27 (51.9%) probands and remained unchanged in two patients. The regression was incomplete in 23 (44.2%) patients who were more obese and whose left ventricular hypertrophy was initially more pronounced. Regression of hypertrophy was not associated with a deterioration in left ventricular function and was achieved even after the addition of vasodilating drugs. No differences were observed between the treatment groups. The pathogenesis of left ventricular hypertrophy still remains unclear. After 2 years, no changes in peripheral vascular resistance in the forearm were observed at reactive hyperaemia. These results indicate that there might be a delay in the regression of vessel hypertrophy compared with that of the left ventricle.