Risk and Management of Hypertension-related Left Ventricular Hypertrophy

Knowledge gained from epidemiological studies and clinical trials on hypertension has led to impressive reductions in morbidity and mortality, particularly from stroke and coronary heart disease (CHD) as complications of end-organ damage from untreated, prolonged systemic hypertension. Data on reductions in stroke when hypertension is treated have been clear and convincing from individual clinical trials. Most of these trials, however, have consistently shown only trends towards a reduction in CHD, and few have individually reported statistically significant reductions. A recent meta-analysis, however, suggests that a significant beneficial reduction in CHD exists when the overall data are examined, although at a lower magnitude of benefit and lesser degree of certainty than for stroke. The presence of left ventricular hypertrophy (LVH) increases the risk of subsequent cardiovascular disease events, cardiovascular mortality and all-cause mortality in hypertensive patients. Although echocardiography appears more sensitive than electrocardiography in diagnosing LVH, much of the information demonstrating risks from LVH is from electrocardiography data, and it is not clear how echocardiography will change the risk prediction. Some data from large clinical trials and populations studies suggest that LVH regresses, particularly if the hypertension is adequately treated. A meta-analysis of a large number of small clinical studies in hypertensive patients suggests that the 4 commonly used antihypertensive drug classes, beta-blockers, diuretics, calcium channel antagonists and ACE inhibitors, are all associated with significant reductions in left ventricular mass. While the primary indication for treatment is clearly the hypertension and not the LVH, the presence of the latter necessitates careful treatment and follow-up of these hypertensive individuals.