Left ventricular hypertrophy and heart failure in women.
The importance of left ventricular hypertrophy (LVH) as a powerful predictor of cardiovascular morbidity and mortality, independent from blood pressure and other cardiovascular risk factors, is widely recognized. Women have a lower prevalence of LVH than men for any given level of blood pressure. The occurrence of LVH increases progressively with older age and LVH becomes more common in women after menopause. Available data indicate that both hypertension and LVH are stronger risk factors for stroke and for heart failure in women than in men. Women are more likely to maintain a better left ventricular systolic function than men with similar heart failure symptoms, and heart failure due to diastolic dysfunction is more common in women than in men. Few studies have demonstrated that patients who fail to achieve a reduction of LVH are much more likely to suffer cardiovascular events than those in whom the left ventricular mass is reduced by antihypertensive treatment. Reversal of LVH therefore represents a major goal in the treatment of hypertensive patients. The degree of cardiac hypertrophy reduction is influenced by baseline severity of LVH, by the duration of treatment and by the degree of 24-h blood pressure control. In addition, beyond the control of blood pressure, different classes of antihypertensive drugs may differently interfere with several non-hemodynamic stimuli, and therefore have a different effect on left ventricular mass. Data regarding the effect of antihypertensive therapy on LVH in women are not adequate. Few studies have suggested a possible additive effect of estrogen replacement therapy on left ventricular mass changes in hypertensive postmenopausal women. Many of the major heart failure intervention trials did not include women or had only a small proportion of female patients. In the SAVE, AIRE, TRACE and SOLVD trials, treatment with angiotensin-converting enzyme inhibitors resulted in similar benefit to women and in men. In studies evaluating the effect of beta-blocker treatment in patients with heart failure, the benefit was statistically significant in men but not in women. Results from further multicenter ongoing trials are awaited to definitely evaluate whether regression of LVH carries a similar benefit in women and men, and whether different therapeutic strategies may be applied to women to regress LVH and to prevent the progression to heart failure.
University of Brescia, c/o Spedali Civili, 2o Medicina generale, Brescia 25100, Italy. agabiti@master cci.unibs.it
Enrico
E
Agabiti-Rosei
Maria Lorenza
ML
Muiesan
D001794:Blood Pressure / Q000502:physiology; D002986:Clinical Trials as Topic; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D016277:Ventricular Function, Left / Q000502:physiology; D016387:Women's Health