Regression of left ventricular hypertrophy by medical treatment: present status and possible implications

Actual regression of left ventricular hypertrophy was shown to occur following some types of antihypertensive therapy both in experimental models and in human subjects with arterial hypertension. This regression was linked to blood pressure control but was not entirely dependent on it; there is growing evidence that adrenergic factors play an important role in modulating the response of the heart to measures lowering arterial pressure. However, generalization would be premature because of the differences reported between various experimental types of hypertension and of the interindividual variations noticed among hypertensive patients receiving similar models of therapy. The reduction in ventricular mass has not been associated with a diminution in overall cardiac performance; in studies of isolated papillary muscle the return of contractility to normal with reversal of hypertrophy has been reported. More investigations are still needed, however, to determine the regressed heart's performance under stress. In that regard, regression of hypertrophy has been associated with normalization of inotropic responsiveness of the heart to adrenergic stimuli. Of particular importance in hypertensive diseases, but as yet incompletely defined, is the extent to which regression of vascular hypertrophy parallels regression of cardiac hypertrophy.