A Contemporary Approach to Hypertensive Cardiomyopathy: Reversing Left Ventricular Hypertrophy

Maximillian T. Bourdillon, Ramachandran S. Vasan

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations

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.

Original languageEnglish (US)
Article number85
JournalCurrent Hypertension Reports
Volume22
Issue number10
DOIs
StatePublished - Oct 1 2020
Externally publishedYes

Keywords

  • Hypertension
  • Hypertensive heart disease
  • Left ventricular hypertrophy
  • Regression
  • Remodeling

ASJC Scopus subject areas

  • Internal Medicine

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