Cardiovascular structural alterations in hypertension: Effect of treatment

Available data support the hypothesis that antihypertensive drugs may determine a significant regression of cardiac and vascular structural changes. Antihypertensive drugs that inhibit the renin-angiotensin or, to a lesser extent, the adrenergic system may more consistently and promptly reduce left ventricular hypertrophy (LVH) and vascular structural changes. It is possible that all antihypertensive agents, when used for long enough periods, will reduce LV mass, whereas only certain drugs will reduce mass within a period of few months, so that any difference among classes of antihypertensive drugs is more quantitative than absolute. However, a rapid reversal of LVH may be particularly important because reducing blood pressure in the presence of an elevated LV mass may be associated with impairment of coronary perfusion. Structural changes of small resistance arteries play a significant role in the genesis of increased vascular resistance in hypertension and in the maintainance of high blood pressure values. Studies in humans have demonstrated that minimal vascular resistance can be reduced with the use of different antihypertensive drugs, while a complete normalization of the media:lumen ratio was observed only with ACE inhibitors. Further studies are needed to assess the true clinical impact, in terms of reduced morbidity and mortality of reversal of cardiovascular structural changes in hypertensive patients. However, available studies indicate that reversal of LVH reduces the pathological consequences of increased left ventricular mass, and preliminary data suggest that complete regression of LVH may be associated to a decreased risk for cardiovascular events.