Management of left ventricular hypertrophy

Left ventricular hypertrophy is a common feature of essential hypertension, and represents at the same time an adaptive process to the increased workload and an independent risk factor for cardiovascular morbidity and mortality. Thus, the reversal of left ventricular hypertrophy has to be considered as the fundamental end point of antihypertensive therapy. Left ventricular hypertrophy is a complex phenotype which is determined by hemodynamic (ie arterial blood pressure and arterial compliance), neurohormonal (ie renin-angiotensin-aldosterone and sympathetic nervous system activity), and hereditary factors (ie race, deletion polymorphism of the angiotensin-converting enzyme gene). Although it is well established that blood pressure reduction is accompanied by a decrease in left ventricular mass, some drugs seem to be more effective than others in preventing or reversing left ventricular hypertrophy despite a similar antihypertensive efficacy. Thus, the choice of therapeutic strategy in the management of left ventricular hypertrophy should take in account this characteristic and above all the ability of the antihypertensive therapy to positively interfere with the pathogenetic mechanisms involved in the development of LV hypertrophy. © 1998, Medikal Press.