Response of hypertensive left ventricular hypertrophy and coronary microvascular disease to calcium antagonists.
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.
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D003326:Coronary Circulation / Q000187:drug effects; D003327:Coronary Disease / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D004719:Endomyocardial Fibrosis / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D008833:Microcirculation / Q000187:drug effects; D009206:Myocardium / Q000473:pathology; D014664:Vasodilation / Q000187:drug effects; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000209:etiology / Q000473:pathology
D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers