Regression of left ventricular hypertrophy and cardiovascular risk changes in hypertensive patients.
Hypertensive left ventricular hypertrophy (LVH) may be detected in about one third of people with hypertension. When an individual with elevated blood pressure develops LVH, the risk of adverse cardiovascular events in the ensuing years almost doubles even in the absence of symptoms. Because of this high added risk, hypertension and other modifiable risk factors should be managed aggressively with lifestyle measures and drugs. LVH can be considered a biological assay which reflects and integrates the long-term exposure not only to pressure overload, but also to several hemodynamic and non-hemodynamic factors which may promote progression and instabilization of atherosclerotic lesions and, ultimately, lead to adverse clinical events. LVH can partially or totally regress following antihypertensive treatment and lifestyle changes including losing excessive weight and decreasing salt intake. Angiotensin II antagonists and ACE-inhibitors seem to be the most effective drugs for reversing LVH. Evidence is accumulating that regression of LVH is associated with a significant reduction in the subsequent risk of cardiovascular disease. According to a recent meta-analysis, effective reversal of LVH is associated with a 59% lesser risk of subsequent adverse events as compared with the persistence or new development of LVH.
Department of Cardiovascular Diseases, R. Silvestrini Hospital, Perugia, Italy. verdec@tin.it
Paolo
P
Verdecchia
Fabio
F
Angeli
Loretta
L
Pittavini
Roberto
R
Gattobigio
Guglielmo
G
Benemio
Carlo
C
Porcellati
D017677:Age Distribution; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D015897:Comorbidity; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D020257:Ventricular Remodeling / Q000187:drug effects / Q000502:physiology
D000959:Antihypertensive Agents; D002316:Cardiotonic Agents