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Time to reconsider the way of selecting antihypertensives for hypertensive left ventricular hypertrophy
Goran Koraćević1,2, Milovan Stojanović2,3, Marija Zdravković4,5
1Department of Cardiology, University Clinical Center Niš, Niš, Serbia.
Insights
Hypertensive left ventricular hypertrophy (HTN LVH) treatment guidelines need updating. Combination antihypertensive therapy, similar to general hypertension management, should be studied and recommended for HTN LVH patients.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Hypertensive left ventricular hypertrophy (HTN LVH) is a common condition with long-standing, unchanged treatment recommendations.
- Current HTN LVH treatment focuses on individual drugs' ability to reverse left ventricular (LV) remodeling.
Purpose of the Study:
- To advocate for updating HTN LVH treatment guidelines.
- To propose adapting HTN LVH therapy to current general hypertension management strategies, emphasizing combination drug therapy.
Main Methods:
- Review of current treatment approaches for HTN LVH.
- Comparison with established combination therapy guidelines for general arterial hypertension (HTN).
Main Results:
- Existing HTN LVH treatment recommendations have remained static for decades.
- General HTN management now often involves initial combination therapy.
Conclusions:
- HTN LVH treatment should evolve to include recommended combinations of two or three antihypertensives, potentially in single pills.
- Further research and clinical trials are needed to establish optimal first- and second-line combination antihypertensive regimens for HTN LVH.
Introduction:
Hypertensive left ventricular hypertrophy (HTN LVH) is a highly prevalent high-risk condition, and the recommendations for HTN LVH treatment are essentially unchanged for several decades.
Areas Covered:
The current therapeutic approach to HTN LVH is to choose antihypertensive drugs according to their ability to reverse left ventricular (LV) remodeling. On the other hand, for the majority arterial hypertension (HTN) patients we should start treatment with a combination of different antihypertensive drugs. Therefore, the goal of antihypertensive treatment of HTN LVH should be adapted to the current recommendation in other parts of guidelines. The recommendation we need is not only which individual drug, but rather which combination of two antihypertensive agents is optimal for reversed LV remodeling.
Expert Opinion:
In this paper, we pointed out that treatment recommendation for HTN LVH can be updated in a similar way as therapy for the whole HTN population - by recommending a combination of two or three antihypertensives in a single pill. Clinicians should be directly advised what is the first- and what the second-line combination of antihypertensives for HTN LVH in evidence-based medicine. Therefore, we suggest that combination treatment should be studied, compared and then recommended also for very prevalent higher-risk HTN LVH patients.
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