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European Heart Journal 1992 13(Supplement D):100-106; doi:10.1093/eurheartj/13.suppl_D.100
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Pharmacotherapeutic effects of antihypertensive agents on myocardium and coronary arteries in hypertension

W. Motz, M. Vogt, S. Scheler and B. E. Strauer

Medical Clinic B, Heinrich-Heine-University of Düsseldorf Germany

Address for correspondence: Wolfgang Molz, MD, Medizinische Einrich-tungen dcr Heinrich-Heine-Universital Düsseldorf, Medizinische Klinik und Poliklink B, Abteilung für Kardiologie, Pneumologie und Angiologie, Moorenstraβe 5, D-4000 Dusseldorf 1, Germany

Hypertensive left ventricular hypertrophy comprises myocyte hypertrophy, interstitial fibrosis and structural alterations in the coronary microcirculation. This leads to impairment of diastolic function in the left ventricle and coronary flow reserve despite normal epicardial arteries. Consequently, antihypertensive treatment should aim at (1) reversing myocyte hypertrophy, (2) restoring myocardial structure and (3) improving coronary flow reserve without lowering blood pressure. In recent years many clinical studies have shown that regression of hypertensive hypertrophy can be induced by long-term treatment with ACE inhibitors, calcium-channel blockers, beta-receptor blockers and antisympathonic drugs. However, vasodilators and diuretics, which stimulate adrenoceptor activity and increase angiotensin II levels, were found to be less effective in reversing left ventricular hypertrophy. The trophic influence of catecholamines and angiotensin II on the myocardium counteracts the effect of systolic wall stress reduction due to blood pressure lowering. As regards reversal of interstitial fibrosis, ACE inhibtors seem to be effective, because fibroblast growth was found to be stimulated by angiotensin II. Recently, clinical studies have confirmed previous experimental data that improvement in impaired coronary vasodilator reserve can be realized by long-term antihypertensive therapy.

In adopting an antihypertensive treatment strategy prime consideration should be given to reversal of cardiac remodelling through restoration of myocardial structure and repair of the coronary microcirculation.

Key Words: Left ventricular hypertrophy • coronary microcirculation • antihypertensive treatment


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