REVERSIBILITY OF LEFT-VENTRICULAR HYPERTROPHY BY ANTIHYPERTENSIVE DRUGS

Although the development of left ventricular hypertrophy in hypertension is mainly explained as a response to an increased pressure load and wall tension, the relation of left ventricular mass with blood pressure is usually weak, even when 24-hour blood pressure monitoring is used, Other factors have therefore been considered, such as anthropometric and demographic characteristics, differences in life-style, genetic influences and neurohumoral factors. Antihypertensive drugs differ in their effects on neurohumoral factors and it has been suggested that these properties may influence their potency to reduce left ventricular mass, mainly on the basis of open single-drug studies. Several prospective randomized comparative studies have however been performed to assess whether some (classes of) drugs are more effective than others in reducing left ventricular mass. A meta-analysis of such studies, comparing diuretics, beta-blockers, calcium antagonists and/or converting enzyme inhibitors, suggests that the reduction of left ventricular mass with each of these classes is similar to the reduction obtained with the other 3 classes statistically combined. Of particular interest is the observation that the 4 studies which compared a converting enzyme inhibitor and a calcium antagonist concluded that the effect on left ventricular mass was not significantly different. There is evidence, however, that drugs such as minoxidil and hydralazine, do not reduce left ventricular mass.