Pharmacological potential in regression of left ventricular hypertrophy in hypertensive patients

Left ventricular hypertrophy (LVH), which is the main manifestation of hypertensive heart disease, is registered in 15-45% of patients with hypertension (HTN), reaching 77% in patients with resistant HTN, concomitant type 2 diabetes and a history of cardiovascular events. The presented review covers the main issues of definition, pathophysiology, epidemiology, diagnostics and regression of LVH with antihypertensive therapy. Recommendations, criteria for detection, advantages and disadvantages of electrocardiography and echocardiography in the management of patients with HTN and LVH are provided. Particular attention in the review is paid to the discussion of LVH influence on the cardiovascular prognosis and the validity of hypertrophy regression. LVH often occurs with the absence or erased clinical manifestations, but over time it increases the risk of heart failure, atrial fibrillation, coronary artery disease, sudden cardiac death, stroke and all-cause death. Timely and adequate antihypertensive therapy allows not only to reduce blood pressure, but also to achieve regression of LVH, which has a favorable effect on the outcome. The main groups of pharmacotherapy causing LVH regression are presented, among which renin-­angiotensin-aldosterone system blockers (angiotensin-­converting enzyme inhibitors, angiotensin II receptor blockers, including in combination with a neprilysin inhibitor), β-blockers, calcium channel blockers, sodium-­glucose cotransporter 2 inhibitors and diuretics are discussed in detail.

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