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Published on: September 25, 2017
Reversibility of left ventricular hypertrophy by antihypertensive drugs
1Department of Molecular and Cardiovascular Research, University of Leuven, Belgium.
Insights
Left ventricular hypertrophy in hypertension is not solely due to blood pressure. Different antihypertensive drug classes show similar efficacy in reducing left ventricular mass.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Left ventricular hypertrophy (LVH) in hypertension is complex, influenced by factors beyond blood pressure.
- The relationship between blood pressure and left ventricular mass is often weak, even with 24-hour monitoring.
- Neurohumoral factors and lifestyle may play a role in LVH development.
Purpose of the Study:
- To compare the effectiveness of different antihypertensive drug classes in reducing left ventricular mass.
- To investigate whether specific drug properties influence their potency in reducing LVH.
- To analyze data from prospective randomized comparative studies on LVH reduction.
Main Methods:
- Meta-analysis of prospective randomized comparative studies.
- Comparison of drug classes including diuretics, beta-blockers, calcium antagonists, and converting enzyme inhibitors.
- Assessment of left ventricular mass reduction as the primary outcome.
Main Results:
- All major antihypertensive drug classes demonstrated similar efficacy in reducing left ventricular mass.
- Converting enzyme inhibitors and calcium antagonists showed comparable effects on LVH.
- Certain drugs like minoxidil and hydralazine did not effectively reduce left ventricular mass.
Conclusions:
- Antihypertensive drug classes exhibit similar effectiveness in reducing left ventricular mass.
- Individual drug properties may not significantly alter LVH reduction compared to standard classes.
- Further research may be needed to understand the non-responders to certain antihypertensive medications.
Abstract:
Although the development of left ventricular hypertrophy in hypertension is mainly explained as a response to an increased pressure load and wall tension, the relation of left ventricular mass with blood pressure is usually weak, even when 24-hour blood pressure monitoring is used. Other factors have therefore been considered, such as anthropometric and demographic characteristics, differences in life-style, genetic influences and neurohumoral factors. Antihypertensive drugs differ in their effects on neurohumoral factors and it has been suggested that these properties may influence their potency to reduce left ventricular mass, mainly on the basis of open single-drug studies. Several prospective randomized comparative studies have however been performed to assess whether some (classes of) drugs are more effective than others in reducing left ventricular mass. A meta-analysis of such studies, comparing diuretics, beta-blockers, calcium antagonists and/or converting enzyme inhibitors, suggests that the reduction of left ventricular mass with each of these classes is similar to the reduction obtained with the other 3 classes statistically combined. Of particular interest is the observation that the 4 studies which compared a converting enzyme inhibitor and a calcium antagonist concluded that the effect on left ventricular mass was not significantly different. There is evidence, however, that drugs such as minoxidil and hydralazine, do not reduce left ventricular mass.
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