A Contemporary Approach to Hypertensive Cardiomyopathy: Reversing Left Ventricular Hypertrophy
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HYPERTENSION AND THE HEART (B UPADHYA, SECTION EDITOR)
A Contemporary Approach to Hypertensive Cardiomyopathy: Reversing Left Ventricular Hypertrophy Maximillian T. Bourdillon 1 & Ramachandran S. Vasan 2,3,4,5,6
# Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Summary 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. Keywords Left ventricular hypertrophy . Regression . Hypertension . Remodeling . Hypertensive heart disease
Introduction Hypertension is a major public health problem in the USA, affecting nearly half of all Americans [1, 2]. Left ventricular hypertrophy (LVH) is a cardinal manifestation of end-organ This article is part of the Topical Collection on Hypertension and the Heart * Ramachandran S. Vasan [email protected] 1
Department of Medicine, Boston University School of Medicine, Boston, MA, USA
2
Framingham Heart Study, Framingham, MA, USA
3
Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
4
Department of Medicine, Sections of Preventative Medicine and Epidemiology and Cardiovascular Medicine, Boston University School of Medicine, Boston, MA, USA
5
Center for Computing and Data Sciences, Boston University, Boston, MA, USA
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
damage due to hypertension; its reported prevalence has ranged from 36 to 41% in echocardiographic studies in individuals with elevated blood pressure [3]. Many longitudinal studies have highlighted the association between LVH, measured by different modalities, and the risk of cardiovascular disease (CVD) [4–7]. Moreover, a graded association between left ventricular mass (LVM) and CVD has been noted [8, 9]. The development of pathologic LVH is classically attributed to a maladapti
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