This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Sharp, A. Articles by Mayet, J. Search for Related Content PubMed PubMed Citation Articles by Sharp, A. Articles by Mayet, J. Social Bookmarking                         What's this?

Regression of left ventricular hypertrophy: hoping for a longer life

International Centre for Circulatory Health, St Mary's Hospital and Imperial College, London, W2 1NY UK

Jamil Mayet

International Centre for Circulatory Health, St Mary's Hospital and Imperial College, London, W2 1NY UK, j.mayet@ ic.ac.uk

Left ventricular hypertrophy (LVH) is more than just an adaptive response to hypertension. It predicts a poor prognosis independently of the blood pressure (BP) level. There is increasing evidence from studies such as Heart Outcomes Prevention Evaluation (HOPE) and Losartan Intervention For Endpoint reduction in hypertension (LIFE) that LVH should be a target for treatment, above and beyond BP control. It is likely that drugs blocking the renin-angiotensin-aldosterone system cause greater regression of LVH than other agents and this is probably the mechanism that explains the superiority of losartan over atenolol in the LIFE study. In order to achieve the stringent BP goals suggested by modern guidelines, most patients will require multiple antihypertensive agents and the clinical choices relate more often to which combinations of drugs are most appropriate, rather than which single drug is the best. Tight BP control should be the first priority and this is likely to lead to regression of LVH.

Key Words: hypertrophy • regression • angiotensin • antihypertensive

References

• Veterans Administrative Cooperative Study Group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension: results in patients with diastolic blood pressures averaging 90 through 114 mmHg. JAMA 1970;213:1143-52.[Abstract/Free Full Text]
• Veterans Administrative Cooperative Study Group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension: results in patients with diastolic blood pressures averaging 115 through 129 mmHg. JAMA 1967;202:116-22.[Abstract/Free Full Text]
• Australian therapeutic trial in mild hypertension. Report by the Management Committee. Lancet 1980;1:1261-7.[Medline] [Order article via Infotrieve]
• Medical Research Council Working Party. MRC Trial of mild hypertension: principal results. BMJ 1985;291:97-104.[Abstract/Free Full Text]
• Collins R, Peto R (eds). Antihypertensive drug therapy: Effects on Stroke and Coronary Heart Disease. London: Blackwell Scientific Publications, 1994:1156-64.
• Staessen, JA, Fagard R., Thija L. et al., for the Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997;350:757-64.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Yusuf S., Sleight P., Pogue J., Bosch J., Davies R., Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;342:145-53.[Abstract/Free Full Text]
• MacMahon S., Neal B., Tzouirion et al. for the PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet 2001;358:1033-41.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Williams, B. The renin angiotensin system and cardiovascular disease: hope or hype? JRAAS 2000;1:142-6.[Medline] [Order article via Infotrieve]
• Blood Pressure Lowering Treatment Trialists' Collaboration: Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs; results of prospectively designed overviews of randomised trials. Lancet 2000;356:1955-64.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Levy D., Garrison RJ, Savage DD, Kannel WB, Castelli WP Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Study. N Engl J Med 1990;322:1561-6.[Abstract]
• Levy D., Salomen M., D'Agostino RB, Belanger AJ, Kannel WB Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. Circulation 1994;90:1786-93.[Abstract/Free Full Text]
• Verdecchia P., Schillaci G., Borgioni C., Ciucci A., Gattobigio R., Zampi I. Prognostic significance of serial changes in left ventricular mass in essential hypertension. Circulation 1998;97:48-54.[Abstract/Free Full Text]
• Weber KT, Brilla CG, Janicki JS Myocardial fibrosis: functional significance and regulatory factors. Cardiovasc Res 1993;27:341-8.[Free Full Text]
• Struthers AD Aldosterone-induced vasculopathy: a new reversible cause of cardiac death. JRAAS 2001;2:211-14.[Medline] [Order article via Infotrieve]
• Liebson PR Clinical studies of drug reversal of hypertensive left ventricular hypertrophy. Am J Hypertens 1990;3:512-17.[Web of Science][Medline] [Order article via Infotrieve]
• Cruickshank JM, Lewis J., Moore V., Dodd C. Reversibility of left ventricular hypertrophy by different types of antihypertensive therapy. J Hum Hypertens 1992;6:85-90.[Web of Science][Medline] [Order article via Infotrieve]
• Dahlöf B., Pennert K., Hansson L. Reversal of left ventricular hypertrophy in hypertensive patients. A meta-analysis of 109 treatment studies. Am J Hypertens 1992;5:95-110.[Web of Science][Medline] [Order article via Infotrieve]
• Schmieder RE, Martus P., Klingbeil A. Reversal of left ventricular hypertrophy in essential hypertension.A meta-analysis of randomised double-blind studies. JAMA 1996;275:1507-13.[Abstract/Free Full Text]
• Dahlöf B., Devereux RB, Kjeldsen SE et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002;359:1003.
• MRC Working Party. Medical Research Council trial of treatment of hypertension in older adults: principal results. BMJ 1992;304:405-12.[Abstract/Free Full Text]
• Davis BR, Cutler JA, Gordon DJ et al. Rationale and design for the antihypertensive and lipid lowering treatment to prevent heart attack trial (ALLHAT). Am J Hypertens 1996;9:342-60.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Sever PS, Dahlöf B., Poulter NR et al. Rationale, design, methods, and baseline demography of participants of the Anglo-Scandinavian Cardiac Outcomes Trial. J Hypertens 2002; 19:1139-47.[CrossRef][Web of Science]
• Kjeldsen SE, Julius S., Brunner H. et al. Characteristics of 15,314 hypertensive patients at high coronary risk.The VALUE trial. The Valsartan Antihypertensive Long-term Use Evaluation. Blood Pressure 2001;10:83-91.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Devereux RB, Palmieri V., Sharpe N. et al. Effects of once-daily angiotensin-converting enzyme inhibition and calcium channel blockade-based antihypertensive treatment regimens on left ventricular hypertrophy and diastolic filling in hypertension: the prospective randomised enalapril study evaluating regression of ventricular enlargement (preserve) trial. Circulation 2001;104:1248-54.[Abstract/Free Full Text]
• Estacio RO, Jefers BW, Hiatt WR et al. The effect of nisoldipine as compared with enalapril on cardiovascular events in patients with non-insulin dependent diabetes and hypertension. N Engl J Med 1998;338:645-52.[Abstract/Free Full Text]
• Tatti P., Pahor M., Byington RP et al. Outcome results of the Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial (FACET) in patients with hypertension and NIDDM. Diabetes Care 1998;21:597-603.[Abstract]
• Mayet J.,Chapman N., Li CK et al. Ethnic differences in the hypertensive heart and the 24 hour blood pressure profile. Hypertension 1998;31:1190-4.[Abstract/Free Full Text]
• Ghali JK, Liao Y., Cooper RS Influence of left ventricular geometric patterns on prognosis in patients with or without coronary artery disease. J Am Coll Cardiol 1998;31:1635-40.[Abstract/Free Full Text]
• Materson BJ, Reda DJ, Cushman WC et al. Single-drug therapy for hypertension in men: a comparison of six antihypertensive agents with placebo. N Engl J Med 1993;328:914-21.[Abstract/Free Full Text]

Journal of Renin-Angiotensin-Aldosterone System, Vol. 3, No. 3, 141-144 (2002)
DOI: 10.3317/jraas.2002.032


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Sharp, A. Articles by Mayet, J. Search for Related Content PubMed PubMed Citation Articles by Sharp, A. Articles by Mayet, J. Social Bookmarking                         What's this?