[Left ventricular hypertrophy in arterial hypertension].
Arterial hypertension is frequently and at an early stage complicated by left ventricular hypertrophy, i.e. an increase in muscular mass due to the proliferation of myofibrillae. This in fact is a physiological mechanism aimed at maintaining systolic function and systemic blood flow rate. Left ventricular hypertrophy may be associated with myocardial alterations, such as increase of collagen, abnormalities of diastolic function, reduced contractility, increased cell excitability and disorders of coronary perfusion. It is responsible for a higher risk of cardiovascular mortality. Antihypertensive treatments, therefore, must not only bring blood pressure down to normal values, but also reduce the myocardial mass. In order to avoid a detrimental effect on coronary reserve, it is highly desirable that arterial hypertension and left ventricular hypertrophy regress simultaneously. Regression of the myocardial hypertrophy associated with arterial hypertension is observed with most antihypertensive drugs, except vasodilators that act directly on the vascular smooth muscle, probably due to stimulation of the sympathetic system. Diuretics also have an inconstant beneficial effect on left ventricular hypertrophy. When a choice has to be made between two drugs that have the same antihypertensive activity, it is the one that also brings about an early and lasting regression of myocardial hypertrophy which must be prescribed.
Garnier
L F
LF
Clinique cardiologique, CHU Trousseau, Tours.
François
G
G
Lang
M
M
Raynaud
P
P
Brochier
M
M
D006332:Cardiomegaly / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology
L'hypertrophie ventriculaire gauche de l'hypertension artérielle.