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Response of hypertensive left ventricular hypertrophy and coronary microvascular disease to calcium antagonists
1Medical Clinic, Heinrich-Heine-University of Düsseldorf, Germany.
Insights
Calcium antagonists effectively lower blood pressure and reverse left ventricular hypertrophy. They also restore heart muscle structure and improve coronary microcirculation in hypertensive patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertensive left ventricular hypertrophy involves myocyte hypertrophy, fibrosis, and coronary microcirculation changes.
- These alterations lead to diastolic and systolic dysfunction, potentially causing heart failure.
- Impaired coronary flow reserve occurs despite normal epicardial arteries.
Purpose of the Study:
- To evaluate calcium antagonists as a treatment for hypertensive cardiac remodeling.
- To assess their effects on left ventricular hypertrophy, myocardial structure, and coronary flow reserve.
Main Methods:
- Review of clinical and experimental studies on calcium antagonist treatment in hypertension.
- Analysis of effects on blood pressure, left ventricular mass, myocardial structure, and coronary vasodilator reserve.
Main Results:
- Calcium antagonists effectively lower blood pressure and induce regression of left ventricular hypertrophy.
- Studies show restoration of myocardial structure and significant improvement in coronary vasodilator reserve.
- Long-term treatment demonstrates repair of coronary microcirculation.
Conclusions:
- Calcium antagonists are a causative treatment for hypertensive cardiac remodeling.
- They offer benefits beyond blood pressure reduction by restoring heart structure and microcirculation.
Abstract:
Hypertensive left ventricular hypertrophy comprises not only myocyte hypertrophy, but is often associated with interstitial fibrosis and structural alterations of the coronary microcirculation. The consequences are early diastolic dysfunction and often later systolic dysfunction of the left ventricle, resulting in congestive heart failure. Involvement of the coronary resistance vessels leads to an impairment of coronary flow reserve despite normal epicardial arteries. Therefore, antihypertensive treatment should aim at reversing myocyte hypertrophy, restoring myocardial structure, and improvement in coronary flow reserve apart from blood pressure lowering. Many clinical studies have shown that calcium antagonists are effective in lowering blood pressure and can induce regression of left ventricular hypertrophy. Moreover, experimental studies have shown a restoration of myocardial structure. Recent clinical studies have demonstrated a marked improvement of the impaired coronary vasodilator reserve in hypertensive patients after long-term treatment with calcium antagonists. In summary, calcium antagonists can be regarded as an antihypertensive treatment modality that is able to restore myocardial structure and to repair coronary microcirculation and therefore can be considered as causative treatment of hypertensive cardiac remodeling.