Regression of left ventricular hypertrophy in hypertension: changing patterns with successive meta-analyses

Left ventricular hypertrophy (LVH) may be an important target for therapy in hypertension, although definitive data in humans are not available. An important question is whether antihypertensive drugs vary in their ability to cause the regression of LVH. Without adequately powered controlled comparisons, meta-analysis provides the best method of assessing the overall results of the numerous smaller published studies. A succession of meta-analyses have indicated a strong relationship between changes in blood pressure and LVH regression. We have reviewed studies conducted for 5 years since the first major meta-analysis. Methodology was found to have improved, and the overall ranking of drug classes according to their effects on LVH regression were: calcium antagonists, angiotensin converting enzyme inhibitors, diuretics, alpha-blockers, beta-blockers, and lifestyle changes. Changes from earlier reports may reflect the use of new preparations within some classes of drugs and large studies are required to define whether this will be reflected in clinical outcomes.