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Compelling therapy of LVH: straight (and not-so-straight) inferences from evidence

Ravi Tejraj Mehta1, Anil Pareek1, Shruti Dharmadhikari1

  • 1Ipca Laboratories Limited, Kandivli Industrial Estate, Kandivli (West), Mumbai, Maharashtra India.

Clinical Hypertension
|December 7, 2019
PubMed

Insights

Chlorthalidone, a diuretic, is superior to ACE inhibitors and CCBs for reducing left ventricle mass and preventing heart failure in hypertension patients. Its pleiotropic effects may explain its benefits in heart failure.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • The Korean Society of Hypertension guidelines recommend ACE inhibitors (ACE-I) and calcium channel blockers (CCB) over diuretics for hypertension with left ventricular hypertrophy (LVH).
  • Landmark trials present conflicting evidence regarding the optimal management of hypertensive patients with LVH.

Purpose of the Study:

  • To evaluate the efficacy of chlorthalidone compared to ACE-I and CCB in managing hypertension with LVH.
  • To explore the relationship between left ventricular mass regression and heart failure (HF) risk reduction.

Main Methods:

  • Review of landmark head-to-head comparison trials in hypertensive patients.
  • Analysis of data comparing chlorthalidone, ACE-I, and CCB effects on left ventricular mass and HF incidence.

Main Results:

  • Chlorthalidone demonstrated superiority over ACE-I and CCB in reducing left ventricular mass.
  • Chlorthalidone was more effective in preventing heart failure compared to ACE-I and CCB.
  • Observed that left ventricular hypertrophy regression does not always correlate with reduced HF risk.

Conclusions:

  • Thiazide-like diuretics, specifically chlorthalidone, should be considered preferentially over ACE-I and CCB for hypertensive patients with LVH.
  • The pleiotropic effects of chlorthalidone may contribute to its significant benefits in preventing heart failure.

Keywords:
ACE-inhibitorsAmlodipineCalcium channel blockersChlorthalidoneGuidelinesHeart failureHypertensionLeft ventricle hypertrophyThiazide diuretics

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