Ultrasound Research Today is a free monthly online journal that collates and summarizes the latest research about Ultrasound, including details on screening, diagnosis, pregnancy, detection.

Patterns of left ventricular hypertrophy in essential hypertension: should echocardiography guide the pharmacological treatment?

Dávila DF, Donis JH, Odreman R, Gonzalez M, Landaeta A

Instituto de Investigaciones Cardiovasculares. Universidad de Los Andes. Mérida, Venezuela. diegod@ula.ve

The experimental design of clinical studies, on the pharmacological treatment of essential hypertension, has ignored a fundamental issue: Hypertensive patients are not a homogenous population. The adaptation of the cardiovascular system to hypertension is structurally and functionally heterogeneous. Recent clinical investigations suggest that this heterogeneity can be minimized by echocardiography. Thus, when the hemodynamic and neurohormonal profiles of untreated hypertensive patients are considered, in the particular context of the cardiac morphologic adaptation to high blood pressure, distinct common denominators emerge. Concentric and eccentric hypertrophy, the two most common patterns of ventricular hypertrophy, are at the extremes of the geometric spectrum. Concentric hypertrophy is characterized by an elliptic left ventricle, normal stroke volume and high peripheral vascular resistance. Its predominant neurohormonal profile includes elevated plasma renin and natriuretic peptide levels. Conversely, most patients with eccentric hypertrophy have a spheric left ventricle, increased stroke volume and low peripheral vascular resistance. Its corresponding neurohormonal profile shows low serum renin and enhanced sympathetic nervous activity. The therapeutic response, to angiotensin II antagonists and to beta-adrenergic blockers, of these two geometric patterns is also different. Concentric hypertrophy is substantially reversed by losartan, whereas, eccentric hypertrophy is refractory to both, losartan and atenolol. These facts raise a relevant question: Should ventricular geometry be considered when deciding which antihypertensive drug is to be prescribed?

Published 4 February 2008 in Int J Cardiol, 124(2): 134-8.
Full-text of this article is available online (may require subscription).

© 2004-2008 Ultrasound Research Today. All Rights Reserved.