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A Contemporary Approach to Hypertensive Cardiomyopathy: Reversing Left Ventricular Hypertrophy

  • Hypertension and the Heart (B Upadhya, Section Editor)
  • Published:
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Abstract

Purpose of Review

To highlight pharmacological and non-pharmacological approaches to reversing hypertensive left ventricular hypertrophy (LVH). We identify high-risk phenotypes that may benefit from aggressive blood pressure (BP) management to prevent incident outcomes such as the development of atherosclerotic cardiovascular disease, stroke, and heart failure.

Recent Findings

LVH is a modifiable risk factor. Intensive BP lowering (systolic BP < 120 mmHg) induces greater regression of electrocardiographic LVH than standard BP targets. The optimal agents for inducing LVH regression include renin–angiotensinogen-aldosterone system inhibitors and calcium channel blockers, although recent meta-analyses have demonstrated superior efficacy of non-hydrochlorothiazide diuretics. Novel agents (such as sacubitril/valsartan) and non-pharmacological approaches (like bariatric surgery) hold promise but longitudinal studies assessing their impact on clinical outcomes are needed.

Summary

LVH regression is achievable with appropriate therapy with first-line antihypertensive agents. Additional studies are warranted to assess if intensive BP lowering in high-risk groups (such as blacks, women, and malignant LVH) improves outcomes.

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Funding

This work is supported by contracts N01-HL25195 and HHSN268201500001I and 75N92019D00031from the National Heart, Lung, and Blood Institute (NHLBI) and NIH grants R01HL142983, HL080124, HL071039, HL077447, HL107385, 1R01HL126136, R01HL131532, and R01HL134168 (RSV). Dr. Vasan is also supported in part by the Evans Medical Foundation and the Jay and Louis Coffman Endowment from the Department of Medicine, Boston University School of Medicine.

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Authors and Affiliations

  1. Department of Medicine, Boston University School of Medicine, Boston, MA, USA

    Maximillian T. Bourdillon

  2. Framingham Heart Study, Framingham, MA, USA

    Ramachandran S. Vasan

  3. Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA

    Ramachandran S. Vasan

  4. Department of Medicine, Sections of Preventative Medicine and Epidemiology and Cardiovascular Medicine, Boston University School of Medicine, Boston, MA, USA

    Ramachandran S. Vasan

  5. Center for Computing and Data Sciences, Boston University, Boston, MA, USA

    Ramachandran S. Vasan

  6. Section of Preventive Medicine and Epidemiology, Boston University Department of Medicine, 72 East Concord Street, Instructional Building, Suite L-510, Boston, MA, 02118, USA

    Ramachandran S. Vasan

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  1. Maximillian T. Bourdillon
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Correspondence to Ramachandran S. Vasan.

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Bourdillon, M.T., Vasan, R.S. A Contemporary Approach to Hypertensive Cardiomyopathy: Reversing Left Ventricular Hypertrophy. Curr Hypertens Rep 22, 85 (2020). https://doi.org/10.1007/s11906-020-01092-8

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