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A Contemporary Approach to Hypertensive Cardiomyopathy: Reversing Left Ventricular Hypertrophy

Maximillian T Bourdillon1, Ramachandran S Vasan2,3,4,5,6

  • 1Department of Medicine, Boston University School of Medicine, Boston, MA, USA.

Current Hypertension Reports
|September 5, 2020
PubMed

Insights

Hypertensive left ventricular hypertrophy (LVH) can be reversed with pharmacological and non-pharmacological treatments. Intensive blood pressure lowering and specific medications effectively reduce LVH, with further research needed for novel agents and high-risk groups.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Pharmacology

Background:

  • Left ventricular hypertrophy (LVH) is a significant, modifiable risk factor for cardiovascular events.
  • Identifying high-risk phenotypes is crucial for targeted blood pressure (BP) management.
  • Preventing outcomes like atherosclerotic cardiovascular disease, stroke, and heart failure is a key clinical goal.

Purpose of the Study:

  • To review pharmacological and non-pharmacological strategies for reversing hypertensive left ventricular hypertrophy (LVH).
  • To identify patient groups that may benefit from aggressive BP management.
  • To discuss the impact of BP control on incident cardiovascular outcomes.

Main Methods:

  • Review of current literature on LVH regression.
  • Analysis of pharmacological agents and their efficacy in reducing LVH.
  • Evaluation of non-pharmacological interventions and their potential impact.

Main Results:

  • Intensive BP lowering (systolic BP < 120 mmHg) promotes greater LVH regression than standard targets.
  • Renin-angiotensin-aldosterone system inhibitors, calcium channel blockers, and non-hydrochlorothiazide diuretics are effective agents for LVH regression.
  • Novel agents and bariatric surgery show promise, but require further clinical outcome studies.

Conclusions:

  • LVH regression is achievable using first-line antihypertensive therapies.
  • Further research is needed to confirm the benefits of intensive BP lowering in high-risk populations.
  • Longitudinal studies are warranted for novel treatments and interventions impacting clinical outcomes.
Abstract

Keywords:
HypertensionHypertensive heart diseaseLeft ventricular hypertrophyRegressionRemodeling

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