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A Contemporary Approach to Hypertensive Cardiomyopathy: Reversing Left Ventricular Hypertrophy

Authors
  • Bourdillon, Maximillian T.1
  • Vasan, Ramachandran S.2, 3, 1, 4, 5
  • 1 Boston University School of Medicine, Boston, MA, USA , Boston (United States)
  • 2 Framingham Heart Study, Framingham, MA, USA , Framingham (United States)
  • 3 Boston University School of Public Health, Boston, MA, USA , Boston (United States)
  • 4 Boston University, Boston, MA, USA , Boston (United States)
  • 5 Boston University Department of Medicine, 72 East Concord Street, Instructional Building, Suite L-510, Boston, MA, 02118, USA , Boston (United States)
Type
Published Article
Journal
Current Hypertension Reports
Publisher
Springer-Verlag
Publication Date
Sep 05, 2020
Volume
22
Issue
10
Identifiers
DOI: 10.1007/s11906-020-01092-8
Source
Springer Nature
Keywords
License
Yellow

Abstract

Purpose of ReviewTo 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 FindingsLVH 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.SummaryLVH 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.

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