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Cardiac involvement in hypertension
1Department of Medicine, University of Texas Medical Branch, Galveston 77550.
Insights
Treating hypertension may not reduce coronary artery disease mortality, even with left ventricular (LV) hypertrophy regression. Some drugs improve LV mass and diastolic function, but their impact on cardiovascular events needs further study.
Area of Science:
- Cardiology
- Hypertension Research
- Pharmacology
Background:
- Hypertension treatment and detection have improved, yet its impact on coronary artery disease mortality is unclear.
- Left ventricular (LV) hypertrophy, a consequence of hypertension, is linked to increased mortality and ventricular arrhythmias.
- Diastolic dysfunction, characterized by reduced ventricular distensibility, is an early sign in hypertensive hearts, preceding significant LV hypertrophy.
Purpose of the Study:
- To investigate the unresolved effect of hypertension treatment on coronary artery disease-related mortality.
- To explore the relationship between left ventricular hypertrophy regression and mortality reduction.
- To determine if antihypertensive agents that improve LV hypertrophy and diastolic function also reduce cardiovascular event risk.
Main Methods:
- Review of existing literature on hypertension, LV hypertrophy, and cardiovascular outcomes.
- Analysis of echocardiographic findings in hypertensive patients regarding diastolic dysfunction.
- Evaluation of the effects of various antihypertensive drug classes on LV mass and diastolic function.
Main Results:
- The effect of hypertension treatment on coronary artery disease mortality remains uncertain.
- LV hypertrophy is associated with increased mortality independent of other risk factors and linked to arrhythmias.
- Diastolic dysfunction is an early finding in hypertension, detectable before significant LV hypertrophy.
- Not all antihypertensive medications reduce LV mass or improve diastolic dysfunction.
- Sympatholytic agents, calcium antagonists, beta-blockers, and ACE inhibitors show potential in reducing LV hypertrophy.
Conclusions:
- Regression of LV hypertrophy may not directly translate to reduced mortality from coronary artery events.
- Certain antihypertensive drug classes appear to reverse LV hypertrophy and improve diastolic dysfunction.
- Further research is required to ascertain if these beneficial effects on LV structure and function translate to reduced coronary artery disease risk.
Abstract:
Despite improved patient detection and pharmacologic therapy, the effect of treatment of hypertension on mortality from coronary artery-related events remains unresolved. Left ventricular (LV) hypertrophy, a known consequence of hypertension, is associated with an excess mortality independent of other known cardiovascular risk factors. Recently, LV hypertrophy accompanying hypertension has been associated with ominous ventricular arrhythmias. However, it does not necessarily follow that regression of LV hypertrophy will reduce this increased mortality. Diastolic dysfunction, manifested by reduced ventricular distensibility of the hypertrophying left ventricle, appears to be an early characteristic of the hypertensive heart since echocardiographic techniques have demonstrated diastolic filling abnormalities in untreated essential hypertensives even before significant LV hypertrophy appears. Not all antihypertensive agents diminish LV mass and improve diastolic dysfunction. Certain sympatholytic agents, calcium antagonists, beta-adrenergic blockers, and the angiotensin-converting enzyme inhibitors appear to diminish LV hypertrophy. However, future studies are needed to determine if these agents that appear to reverse findings of LV hypertrophy and improve diastolic dysfunction will also reduce risk of coronary artery disease and related events.