Prevention, diagnosis, and treatment of hypertensive heart disease

Abstract

Hypertensive heart disease (HHD), a result of long-standing hypertension, is characterized by changes in the myocardial structure and function in the absence of other primary cardiovascular abnormalities. Although increased blood pressure is the initiating stimulus, neurohormonal factors, particularly the renin-angiotensin system, play a key role in remodeling of cardiac chamber geometry and walls. Optimal antihypertensive therapy in the setting of therapeutic lifestyle changes is crucial in the prevention and control of HHD. Regression of left ventricular hypertrophy (LVH) is achievable and associated with improved prognosis. However, prevention of myocardial remodeling before LVH establishes would further increase the benefits to cardiac function and prognosis. Antihypertensive agents exhibit variable effectiveness in inducing LVH regression. Currently, renin-angiotensin system blocking agents seem to be the most effective approach for LVH regression and reverse remodeling in these patients.