Copyright © 1993 by the European Society of Cardiology.
© 1993 The European Society of Cardiology
Management of the patient with left ventricular hypertrophy
Clinical Methodology—Cardioangiology Unit, Second Medical School, ‘Federico II’ University of Naples Naples, Italy
Correspondence: Professor Oreste de Divitiis, Director, Clinical Methodology, University of Naples, Parco Comola Ricci 147, Naples 80121, Italy.
The management of left ventricular hypertrophy (LVH) presupposes that the patient is identified by echocardiography and is carefully evaluated for risk stratification, taking into consideration possible associated complications. The role of nonpharmacological treatment is limited, except in obese patients. Drug treatment, especially using calcium antagonists, angiotensin converting enzyme inhibitors and beta-blockers, has proved to be effective in reducing LVH. These drugs are also effective in controlling, if not reversing, the associated pathophysiological changes and complications, such as impaired systolic and diastolic function, and ventricular arrhythmias. There is, however, no evidence of any beneficial effect on myocardial ischaemia. The desirable goal is LVH regression, but it may not be achievable in over 50% of patients, and it is not possible to identify patients in whom regression is likely. Regression, or control of each sequelae, could prevent sudden death, the evolution of hypertensive heart disease leading to heart failure and, probably, myocardial infarction. Patients must be followed carefully during and, particularly, at the beginning of the antihypertensive therapy which has to begradually introduced. At best, blood pressure must be reduced while avoiding hypotension. The strategy of antihypertensive treatment has to be reconsidered on the basis of the presence of LVH and could lead to decreased cardiovascular morbidity and mortality of patients with LVH.
Key Words: Hypertrophy • left ventricular function • arrhythmias • myocardial ischaemia • antihypertensive drugs