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Published on: June 15, 2020
Left ventricular hypertrophy: its prime importance as a controllable risk factor
1Philadelphia Heart Institute, Presbyterian-University of Pennsylvania Medical Center 19104.
Insights
Left ventricular hypertrophy (LVH) is a significant cardiac risk. While some antihypertensive drugs like beta-blockers can reverse LVH, others cannot, impacting long-term cardiac event risk.
Area of Science:
- Cardiology
- Hypertension Research
- Cardiac Imaging
Background:
- Left ventricular hypertrophy (LVH) is an abnormal increase in left ventricle mass.
- LVH is an independent risk factor for myocardial infarction, heart failure, and sudden death.
- Electrocardiography detects LVH in 5% of hypertensive patients, while echocardiography detects it in 50%.
Purpose of the Study:
- To evaluate the impact of antihypertensive pharmacotherapy on reversing left ventricular hypertrophy.
- To compare the efficacy of different antihypertensive medication classes in reversing LVH.
- To assess potential improvements in cardiac function associated with LVH reversal.
Main Methods:
- Review of studies assessing left ventricular mass changes in hypertensive patients under pharmacotherapy.
- Comparison of echocardiographic data before and after treatment with various antihypertensive agents.
- Analysis of cardiac index, peripheral resistance, and diastolic function parameters.
Main Results:
- Pharmacological control of hypertension can normalize left ventricular mass.
- Diuretics and vasodilators have not shown efficacy in reversing LVH.
- Beta-blockers have demonstrated the ability to reverse LVH over 18–24 months.
- LVH reversal may improve cardiac index, reduce peripheral resistance, and enhance diastolic function.
Conclusions:
- Left ventricular hypertrophy reversal is achievable with specific antihypertensive medications, notably beta-blockers.
- The long-term impact of LVH reversal on reducing cardiac events requires further investigation.
- Certain antihypertensive agents may offer superior long-term cardiovascular risk reduction.
Abstract:
Left ventricular hypertrophy, which is defined as an abnormal increase in the mass of the left ventricle, has become recognized as an important independent risk factor for predicting several untoward cardiac events, including myocardial infarction, congestive heart failure, and sudden death. The presence of left ventricular hypertrophy is difficult to detect by electrocardiography but can be accurately assessed by echocardiography. Left ventricular hypertrophy can be detected in about 5% of all hypertensive patients by electrocardiography but is found in about 50% by echocardiography. Although it is possible to restore left ventricular mass to normal by controlling hypertension with pharmacotherapy, several commonly prescribed antihypertensive medications, including diuretics and vasodilators, have failed to demonstrate the ability to reverse left ventricular hypertrophy. Other agents, including most beta-blockers, have been found to reverse it. Reversal may take 18 to 24 months from the initiation of therapy. This reversal may be accompanied by an increase in cardiac index, reductions in total peripheral resistance, and improvements in the diastolic properties of the left ventricle. It has yet to be determined whether these improvements reduce the risk of myocardial infarction, heart failure, and sudden death. However, it is likely that some antihypertensive medications may be superior to others in reducing long-term cardiac risks.
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