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[Left ventricular hypertrophy in arterial hypertension]
L F Garnier1, G François, M Lang
1Clinique cardiologique, CHU Trousseau, Tours.
Insights
Arterial hypertension often leads to left ventricular hypertrophy, increasing cardiovascular mortality risk. Effective antihypertensive treatments should normalize blood pressure and regress myocardial mass for better patient outcomes.
Area of Science:
- Cardiology
- Hypertension Research
- Cardiac Physiology
Context:
- Arterial hypertension is a prevalent condition frequently complicated by left ventricular hypertrophy (LVH).
- LVH, an increase in cardiac muscle mass, is a physiological response to maintain cardiac output but can lead to detrimental myocardial alterations.
- These alterations include increased collagen, impaired diastolic function, reduced contractility, and coronary perfusion disorders, elevating cardiovascular mortality risk.
Purpose:
- To evaluate the impact of antihypertensive treatments on left ventricular hypertrophy regression.
- To determine the ideal characteristics of antihypertensive drugs considering both blood pressure control and cardiac remodeling.
- To emphasize the importance of simultaneous regression of arterial hypertension and LVH.
Summary:
- Left ventricular hypertrophy is a common early complication of arterial hypertension, characterized by increased myocardial mass and potential adverse alterations.
- While many antihypertensive drugs promote LVH regression, direct vasodilators and diuretics may have inconsistent or detrimental effects.
- The study highlights that antihypertensive agents should not only lower blood pressure but also reduce myocardial mass for optimal cardiovascular protection.
Impact:
- Antihypertensive therapy selection should prioritize drugs that achieve early and sustained regression of left ventricular hypertrophy alongside blood pressure normalization.
- This approach is crucial for mitigating cardiovascular mortality associated with hypertension and LVH.
- Choosing antihypertensive medications with regression capabilities can significantly improve long-term patient prognosis and reduce cardiac remodeling.
Abstract:
Arterial hypertension is frequently and at an early stage complicated by left ventricular hypertrophy, i.e. an increase in muscular mass due to the proliferation of myofibrillae. This in fact is a physiological mechanism aimed at maintaining systolic function and systemic blood flow rate. Left ventricular hypertrophy may be associated with myocardial alterations, such as increase of collagen, abnormalities of diastolic function, reduced contractility, increased cell excitability and disorders of coronary perfusion. It is responsible for a higher risk of cardiovascular mortality. Antihypertensive treatments, therefore, must not only bring blood pressure down to normal values, but also reduce the myocardial mass. In order to avoid a detrimental effect on coronary reserve, it is highly desirable that arterial hypertension and left ventricular hypertrophy regress simultaneously. Regression of the myocardial hypertrophy associated with arterial hypertension is observed with most antihypertensive drugs, except vasodilators that act directly on the vascular smooth muscle, probably due to stimulation of the sympathetic system. Diuretics also have an inconstant beneficial effect on left ventricular hypertrophy. When a choice has to be made between two drugs that have the same antihypertensive activity, it is the one that also brings about an early and lasting regression of myocardial hypertrophy which must be prescribed.