Cardioprotective mechanisms of lifestyle modifications and pharmacotherapies on cardiac remodeling and dysfunction in hypertensive heart disease: an overview.

The incidence of cardiovascular events in hypertensive patients is clearly related to a left ventricular mass during treatment, and a regression of left ventricular hypertrophy is associated with a better prognosis. This is the case even independently of changes in other risk factors, including blood pressure. Evidence indicates that lifestyle modifications such as dietary salt restriction and weight loss are effective means in preventing the development of hypertension and reducing blood pressure and left ventricular mass in hypertensive patients. Salt restriction may also reduce the long-term risk of cardiovascular events. It has been recognized that the primary targets of current antihypertensive drugs are the renin-angiotensin-aldosterone system, calcium homeostasis, the ionic transport mechanisms in the kidneys, and the sympathetic nervous system. Clinical as well as experimental studies have demonstrated the cardioprotective effects of antihypertensive drugs independently of their blood pressure lowering effects. Hypertension is often complicated by other disease states including diabetes, dyslipidemia, and ischemic heart disease. Some of the drugs used for the treatment of such complications are also shown to produce cardioprotective effects in addition to their original effects. We ought to better understand these pleiotropic effects for the most effective treatments of hypertension and its complications.