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Management of hypertension in patients with left ventricular hypertrophy

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Abstract

Left ventricular hypertrophy (LVH) is a cardinal manifestation of organ damage in patients with arterial hypertension. Identifying LVH is a fundamental step in evaluating hypertensive patients, because clinical and epidemiologic studies have shown this condition has a strong independent adverse prognostic significance. LVH is an integrated marker of cardiovascular risk, reflecting hypertension’s hemodynamic and nonhemodynamic effects on the heart. Reversing LVH is an intermediate goal of antihypertensive therapy. Pharmacologic strategies to reverse LVH should be based on combining two or more drugs: a renin-angiotensin system blocker (ie, angiotensin-converting enzyme inhibitor or angiotensin receptor antagonist), and a calcium antagonist or low-dose diuretic. Successful therapeutic plans should also include nonpharmacologic interventions to promote LVH regression.

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References and Recommended Reading

  1. Jennings GLR, McMullen JR: Left ventricular hypertrophy: beyond the image and defining the human cardiac phenotype in hypertension. J Hypertens 2007, 25:941–947.

    Article  PubMed  CAS  Google Scholar 

  2. Koren MJ, Devereux RB, Casale PN, et al.: Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Med Intern 1991, 114:345–352.

    CAS  Google Scholar 

  3. Mensah GA, Pappas TW, Koren MJ, et al.: Comparison of classification of hypertension severity by blood pressure level and World Health Organization criteria for prediction of concurrent cardiac abnormalities and subsequent complications in essential hypertension. J Hypertens 1993, 11:1429–1440.

    Article  PubMed  CAS  Google Scholar 

  4. Levy D, Garrison RJ, Savage DD, et al.: Prognostic implications of echocardiographically-determined left ventricular mass in the Framingham Study. N Engl J Med 1990, 322:1561–1566.

    Article  PubMed  CAS  Google Scholar 

  5. Bikkina M, Levy D, Evans JC, et al.: Left ventricular mass and the risk of stroke in an elderly cohort: the Framingham Study. JAMA 1994, 272:33–36.

    Article  PubMed  CAS  Google Scholar 

  6. Liao Y, Cooper RS, McGee DL, et al.: The relative effects of left ventricular hypertrophy, coronary artery disease, and ventricular dysfunction on survival among black adults. JAMA 1995, 273:1592–1597.

    Article  PubMed  CAS  Google Scholar 

  7. Klingbeil AU, Schneider M, Martus P, et al.: A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension. Am J Med 2003, 115:41–46.

    Article  PubMed  Google Scholar 

  8. Trimarco B, De Luca N, Ricciardelli B, et al.: Cardiac function in systemic hypertension before and after reversal of left ventricular hypertrophy. Am J Cardiol 1988, 62:745–750.

    Article  PubMed  CAS  Google Scholar 

  9. Perlini S, Muiesan ML, Cuspidi C, et al.: Midwall mechanics are improved after regression of hypertensive left ventricular hypertrophy and normalization of chamber geometry. Circulation 2001, 103:678–683.

    PubMed  CAS  Google Scholar 

  10. Magrini F, Reggiani P, Roberts N, et al.: Effects of angiotensin blockade on coronary circulation and coronary reserve. Am J Med 1988, 84:55–60.

    Article  PubMed  CAS  Google Scholar 

  11. Koren MJ, Ulin RJ, Laragh JH, Devereux RB: Reduction of left ventricular mass during treatment of essential hypertension is associated with improved prognosis. Am J Hypertens 2002, 15:1021–1028.

    Article  PubMed  Google Scholar 

  12. Muiesan ML, Salvetti M, Rizzoni D, et al.: Association of change in left ventricular mass with prognosis during long-term antihypertensive treatment. J Hypertens 1995, 13:1091–1105.

    Article  PubMed  CAS  Google Scholar 

  13. Verdecchia P, Schillaci G, Borgioni C, et al.: Prognostic significance of serial changes in left ventricular mass in essential hypertension. Circulation 1998, 97:48–54.

    PubMed  CAS  Google Scholar 

  14. Cipriano C, Gosse P, Bemurat L, et al.: Prognostic value of left ventricular mass and its evolution during treatment in the Bordeaux cohort of hypertensive patients. Am J Hypertens 2001, 14:524–529.

    Article  PubMed  CAS  Google Scholar 

  15. Levy D, Salomon MD, Agostino RB, et al.: Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. Circulation 1994, 90:1786–1793.

    PubMed  CAS  Google Scholar 

  16. Olivetti G, Melissari M, Balbi T, et al.: Myocyte cellular hypertrophy is responsible for ventricular remodeling in the hypertrophic heart of middle aged individuals in the absence of heart failure. Cardiovasc Res 1994, 28:1199–1208.

    PubMed  CAS  Google Scholar 

  17. Rossi MA: Pathologic fibrosis and connective tissue matrix in left ventricular hypertrophy due to chronic arterial hypertension in humans. J Hypertens 1998, 16:1031–1041.

    Article  PubMed  CAS  Google Scholar 

  18. Ciulla MM, Paliotti R, Hess DB, et al.: Echocardiographic patterns of myocardial fibrosis in hypertensive patients: endomyocardial biopsy versus ultrasonic tissue characterization. J Am Soc Echocardiogr 1997, 10:657–664.

    Article  PubMed  CAS  Google Scholar 

  19. Brilla C, Funck RC, Rupp H: Lisinopril-mediated regression of myocardial fibrosis in patients with hypertensive heart disease. Circulation 2000, 102:1388–1393.

    PubMed  CAS  Google Scholar 

  20. Weber KT: Fibrosis and hypertensive heart disease. Curr Opin Cardiol 2000, 15:264–272.

    Article  PubMed  CAS  Google Scholar 

  21. Campbell JE, Janicki JS, Weber KT: Temporal differences in fibroblast proliferation and phenotype expression in response to chronic administration of angiotensin II or aldosterone. J Mol Cell Cardiol 1995, 27:1545–1560.

    Article  PubMed  CAS  Google Scholar 

  22. Levy D, Lahib SB, Anderson KM, et al.: Determinants of sensitivity and specificity of electrocardiographic criteria for left ventricular hypertrophy. Circulation 1990, 81:815–820.

    PubMed  CAS  Google Scholar 

  23. Mancia G, De Backer G, Dominiczak A, et al.: 2007 Guidelines for the Management of Arterial Hypertension. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007, 25:1105–1187.

    Article  PubMed  CAS  Google Scholar 

  24. Lang RM, Bierig M, Devereux RB, et al.; American Society of Echocardiography’s Nomenclature and Standards Committee; Task Force on Chamber Quantification; American College of Cardiology/Echocardiography Committee; American Heart Association; European Association of Echocardiography, European Society of Cardiology: Recommendations for chamber quantification. Eur J Echocardiogr 2006, 7:79–108.

    Article  PubMed  Google Scholar 

  25. Mancia G, Carugo S, Grassi G, et al.: Prevalence of left ventricular hypertrophy in hypertensive patients without and with blood pressure control. Data from the PAMELA population. Hypertension 2002, 39:744–749.

    Article  PubMed  CAS  Google Scholar 

  26. Cuspidi C, Meani S, Fusi V, et al.: Metabolic syndrome and target organ damage in untreated essential hypertensives. J Hypertens 2004, 22:1991–1998.

    Article  PubMed  CAS  Google Scholar 

  27. Cuspidi C, Ambrosioni E, Mancia G, et al.; APROS Investigators: Role of echocardiography and carotid ultrasonography in stratifying risk in patients with essential hypertension: the Assessment of Prognostic Risk Observational Survey. J Hypertens 2002, 20:1307–1314.

    Article  PubMed  CAS  Google Scholar 

  28. Cuspidi C, Lonati L, Sampieri L, et al.: Prevalence of target organ damage in treated hypertensive patients: different impact of clinic and ambulatory blood pressure control. J Hypertens 2000, 18:803–809.

    Article  PubMed  CAS  Google Scholar 

  29. Cuspidi C, Macca G, Sampieri L, et al.: High prevalence of cardiac and extracardiac target organ damage in refractory hypertension. J Hypertens 2001, 19:2063–2070.

    Article  PubMed  CAS  Google Scholar 

  30. Cuspidi C, Muiesan ML, Valagussa L, et al.: Comparative effects of candesartan and enalapril on left ventricular hypertrophy in patients with essential hypertension: the Candesartan Assessment in the Treatment of Cardiac Hypertrophy (CATCH) study. J Hypertens 2002, 20:2293–2300.

    Article  PubMed  CAS  Google Scholar 

  31. Devreux RB, Dahlof B, Gerdts E, et al.: Regression of hypertensive left ventricular hypertrophy by losartan compared with atenolol: the losartan intervention for endpoint reduction in hypertension (LIFE) trial. Circulation 2004, 110:1456–1462.

    Article  CAS  Google Scholar 

  32. Gosse P, Sheridan DJ, Zannad F, et al.: Regression of left ventricular hypertrophy in hypertensive patients treated with indapamide SR 1.5 mg versus enalapril 20 mg: the LIVE study. J Hypertens 2000, 18:1465–1475.

    Article  PubMed  CAS  Google Scholar 

  33. Agabiti-Rosei E, Trimarco B, Muiesan ML, et al.: Cardiac structural and functional changes during long-term antihypertensive treatment with lacidipine and atenolol in the European Lacidipine Study on Atherosclerosis (ELSA). J Hypertens 2005, 23:1091–1098.

    PubMed  CAS  Google Scholar 

  34. Dahlof B, Zanchetti A, Diez J, et al.; REGAAL Study Investigators: Effect of losartan and atenolol on left ventricular mass and neurohormonal profile in patients with essential hypertension and left ventricular hypertrophy. J Hypertens 2002, 20:1855–1864.

    Article  PubMed  Google Scholar 

  35. Ciulla MM, Paliotti R, Esposito A, et al.: Different effects of antihypertensive therapies based on losartan or atenolol on ultrasound and biochemical markers of myocardial fibrosis. Results of a randomized trial. Circulation 2004, 110:552–557.

    Article  PubMed  CAS  Google Scholar 

  36. Devereux RB, Palmieri V, Sharpe N, et al.: Effects of once-daily angiotensin-converting enzyme inhibition and calcium channel blockade-based antihypertensive treatment regimens on left ventricular hypertrophy and diastolic filling in hypertension. The Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement (PRESERVE) Trial. Circulation 2001, 104:1248–1254.

    Article  PubMed  CAS  Google Scholar 

  37. Terpstra WF, May JF, Smit AJ, et al.: Long-term effects of amlodipine and lisinopril on left ventricular mass and diastolic function in elderly, previously untreated hypertensive patients: the ELVERA trial. J Hypertens 2001, 19:303–309.

    Article  PubMed  CAS  Google Scholar 

  38. Müller-Brunotte R, Edner M, Malmqvist K, Kahan T: Irbesartan and atenolol improve diastolic function in patients with hypertensive left ventricular hypertrophy. J Hypertens 2005, 23:633–640.

    Article  PubMed  Google Scholar 

  39. Diez J, Querejeta R, Lopez B, et al.: Losartan-dependent regression of myocardial fibrosis is associated with reduction of left ventricular chamber stiffness in hypertensive patients. Circulation 2002, 105:2512–2517.

    Article  PubMed  CAS  Google Scholar 

  40. Bella JN, Palmieri V, Wachtell K, et al.: Sex-related difference in regression of left ventricular hypertrophy with antihypertensive treatment: the LIFE study. J Hum Hypertens 2004, 18:411–416.

    Article  PubMed  CAS  Google Scholar 

  41. Manolio TA, Levy D, Garrison RJ, et al.: Relation of alcohol intake in left ventricular mass: the Framingham Study. J Am Coll Cardiol 1991, 17:77–721.

    Article  Google Scholar 

  42. Liebson PR, Grandits TA, Dianzumba S, et al.: Comparison of five antihypertensive monotherapies and placebo for change in left ventricular mass in patients receiving nutritional hygienic therapy in the Treatment of Mild Hypertension Study (THOMS). Circulation 1995, 91:698–706.

    PubMed  CAS  Google Scholar 

  43. Chobanian AV, Bakris GL, Black HR, et al.: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003, 289:2560–2572.

    Article  PubMed  CAS  Google Scholar 

  44. Roman MJ, Saba PS, Pini R, et al.: Parallel cardiac and vascular adaptation in hypertension. Circulation 1992, 86:1909–1918.

    PubMed  CAS  Google Scholar 

  45. De Luca N, Mallion JM, O’Rourke MF, et al.: Regression of left ventricular mass in hypertensive patients treated with perindopril/indapamide as a first line-line combination: the REASON echocardiography study. Am J Hypertens 2004, 17:660–667.

    PubMed  Google Scholar 

  46. Dahlof B, Gosse P, Gueret P, et al.: Perindopril/Indapamide combination more effective than enalapril in reducing blood pressure and left ventricular mass: the PICXEL study. J Hypertens 2005, 23:2063–2070.

    Article  PubMed  Google Scholar 

  47. Dahlof B, Sever PS, Poulter NR, et al.: Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendoflumethiazide as required in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentric randomized controlled trial. Lancet 2005, 366:895–906.

    Article  PubMed  CAS  Google Scholar 

  48. Cuspidi C, Meani S, Valerio C, et al.: Effects of angiotensin II receptor blockade-based therapy with losartan on left ventricular hypertrophy and geometry in previously treated hypertensive patients. Blood Press 2006, 15:107–115.

    Article  PubMed  CAS  Google Scholar 

  49. Su SF, Hsiao CL, Chu CW, et al.: Effects of pravastatin on left ventricular mass in patients with hyperlipidemia and essential hypertension. Am J Cardiol 2000, 86:514–518.

    Article  PubMed  CAS  Google Scholar 

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  1. Policlinico di Monza, Via Amati 111, 20052, Monza, Italy

    Cesare Cuspidi

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  1. Cesare Cuspidi
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  2. Carla Sala
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  3. Alberto Zanchetti
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Correspondence to Cesare Cuspidi.

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Cuspidi, C., Sala, C. & Zanchetti, A. Management of hypertension in patients with left ventricular hypertrophy. Current Science Inc 9, 498–505 (2007). https://doi.org/10.1007/s11906-007-0091-6

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