An updated concept for left ventricular hypertrophy risk in hypertension.

Left ventricular hypertrophy (LVH) was one of the first three "factors of risk" originally identified by the Framingham Heart Study predisposing the patient to premature morbidity and mortality resulting from coronary heart disease. Among the initial approaches toward specific risk reduction were antihypertensive agents that reduce left ventricular (LV) mass with control of arterial pressure. However, the indication to reduce risk from LVH has not been approved by the federal regulatory agency. All drugs that reduce arterial pressure are capable of decreasing LV mass. More recently, investigative efforts in the laboratory and clinic have focused on identifying specific epiphenomena that are responsible for risk; they include ischemia, fibrosis, apoptosis, dietary salt excess, and inflammatory factors. Newer clinical methods are becoming available to diagnose these alterations. Current antihypertensive therapy and management improve coronary blood flow and flow reserve, diminish ventricular fibrosis and apoptosis, employ established educational interventions to reduce dietary salt intake, and may prevent inflammatory factors (although the latter factor requires further study; and others, no doubt, will continue to be identified). Thus, present knowledge is available to apply this more current paradigm for the treatment of hypertension and to reduce risk from LVH.