Maximillian T Bourdillon1, Ramachandran S Vasan2,3,4,5,6. 1. Department of Medicine, Boston University School of Medicine, Boston, MA, USA. 2. Framingham Heart Study, Framingham, MA, USA. vasan@bu.edu. 3. Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA. vasan@bu.edu. 4. Department of Medicine, Sections of Preventative Medicine and Epidemiology and Cardiovascular Medicine, Boston University School of Medicine, Boston, MA, USA. vasan@bu.edu. 5. Center for Computing and Data Sciences, Boston University, Boston, MA, USA. vasan@bu.edu. 6. Section of Preventive Medicine and Epidemiology, Boston University Department of Medicine, 72 East Concord Street, Instructional Building, Suite L-510, Boston, MA, 02118, USA. vasan@bu.edu.
Abstract
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.
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.
Entities:
Keywords:
Hypertension; Hypertensive heart disease; Left ventricular hypertrophy; Regression; Remodeling