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[Hypertension, left ventricular hypertrophy and heart failure]
G Mancia1, C Giannattasio, G Grassi
1Cattedra di Medicina Interna, Ospedale S. Gerardo dei Tintori di Monza, Università degli Studi di Milano.
Insights
High blood pressure often causes cardiac hypertrophy, a condition that impairs heart function and increases risks of heart attack and failure. Treating high blood pressure with medications can reverse cardiac hypertrophy and restore normal heart function.
Area of Science:
- Cardiology
- Hypertension Research
Context:
- Cardiac hypertrophy is a common complication of high blood pressure (hypertension).
- Pathological cardiac hypertrophy negatively impacts diastolic function, coronary circulation, and cardiovascular reflex control.
- It is associated with increased risks of arrhythmias, myocardial infarction, heart failure, and sudden cardiac death.
Purpose:
- To review the pathophysiological and clinical implications of cardiac hypertrophy in hypertension.
- To highlight the role of antihypertensive medications in managing cardiac hypertrophy.
Summary:
- Over 30 years of research confirm cardiac hypertrophy's link to hypertension, affecting disease progression.
- Cardiac hypertrophy impairs heart function by increasing wall thickness, affecting diastolic function and oxygen consumption.
- Clinical outcomes include increased risk of arrhythmias, myocardial infarction, heart failure, and sudden cardiac death.
Impact:
- Antihypertensive therapies (e.g., ACE-inhibitors, calcium antagonists, alpha/beta-blockers) reduce blood pressure.
- These treatments promote regression of cardiac hypertrophy, evidenced by echo- and electrocardiographic changes.
- Restoration of normal cardiac function and homeostatic cardiovascular control is achieved through blood pressure management.
Abstract:
Epidemiological and clinical studies carried out over the past 30 years have unequivocally shown that cardiac hypertrophy is frequently associated with high blood pressure values adversely affecting, from a pathophysiological and prognostic view point, the clinical evolution of the hypertensive disease. From a pathophysiological view point, it has been reported that a pathologic increase in cardiac wall thickness not only impairs diastolic function, coronary circulation and reflex control of circulation exerted by cardiopulmonary volume receptors, but also enhances cardiac work and myocardial oxygen consumption. From a clinical view point, cardiac hypertrophy has been shown to increase the risk of occurrence of cardiac arrhythmias, myocardial infarction, heart failure and sudden cardiac death. Antihypertensive drugs, such as ACE-inhibitors, calcium antagonists and alpha and beta-blocking agents, by reducing high blood pressure values and concomitantly by favouring the regression of the echo- and electrocardiographic signs of cardiac hypertrophy, have been shown to physiologically restore normal cardiac function and reflex homeostatic cardiovascular control.