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JOURNAL ARTICLE
RESEARCH SUPPORT, N.I.H., EXTRAMURAL
RESEARCH SUPPORT, NON-U.S. GOV'T
REVIEW
A Contemporary Approach to Hypertensive Cardiomyopathy: Reversing Left Ventricular Hypertrophy.
Current Hypertension Reports 2020 September 6
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. 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.
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. 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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