[Ventricular hypertrophy as an expression of hypertensive damage]

Abstract

Although left ventricular hypertrophy is an adaptative mechanism to increased load, its development represents a pathological state which can affect patients' health in many ways. Systemic hypertension is often associated to left ventricular hypertrophy; a correlation exists between ambulatory blood pressure monitoring daytime mean blood pressure values and left ventricular mass. Left ventricular hypertrophy is an independent risk factor for cardiovascular events, and the pattern of concentric left ventricular hypertrophy is associated with higher morbidity and mortality. The mechanism by which left ventricular hypertrophy impair life expectancy is not completely known; arrhythmias and ischemia may often develop in patients with secondary left ventricular hypertrophy and can contribute to worsen prognosis. Left ventricular mechanics is also affected by hypertrophy. Systolic function is usually normal at rest, but its response to exercise can be blunted when hypertrophy develops. Diastolic dysfunction is often present in patients with hypertension, even before left ventricular hypertrophy occurs, and it can impair systolic function by hampering filling resulting mostly in an impairment in the adjustment to exercise. Effective antihypertensive therapy leads to a decrease in left ventricular hypertrophy and an improvement in diastolic mechanics.