LEFT-VENTRICULAR HYPERTROPHY IN MILD ESSENTIAL-HYPERTENSION - ITS PROGRESSION, PREDICTION AND TREATMENT STRATEGY

Since the pathogenesis of left ventricular hypertrophy (LVH) in hypert ension is thought to be multifactorial, the antihypertensive strategy also has to be multifaceted. Diagnosis of LVH is more reliable than ev er with echocardiography either of the M-mode or 2D method. Diagnostic criteria have already been proposed by Ganau et al who classified LV morphology into 4 different sectors based on the standard values of le ft ventricular mass index (LVMI) and relative wall thickness in diasto le (RWTd); normal, concentric remodeling, concentric hypertrophy and e ccentric hypertrophy. The concentric hypertrophy pattern is the most r isky with regard to prognosis. Therefore, its detection and prediction for further progression have to be conducted with relatively easy rou tine work-up procedures such as echocardiography and maximal exercise testing. The prediction of LVH progression has already been proposed b ased on several studies conducted in patients with borderline or mild hypertension. The following two predictors were defined as LVMI > 124 g/m(2) and peak Ps at maximal exercise testing > 200 mmHg. Therefore, the patient who meets these criteria has to be treated with medication s that are appropriately selected on an individualized basis. Both hyp erinsulinemia and insulin resistance are thought to be involved in the initiation, promotion and potentiation of remodeling of the LV in hyp ertension. Physical fitness also seems to be decreased in a parallel m anner. Selection of the most appropriate drug for a given patient has to be individually determined based on the risks that have to be corre cted. Finally, arteriosclerosis, which is almost always initiated and progresses in concert with hypertension, must also be targeted with re gard to such prognostic aspects as cardiovascular morbidity and mortal ity. Arteriosclerosis is pathogenetically independent from hypertensio n, but usually behaves in concert with it. Selection of medication mus t be focussed on an individualized basis not only for LVH, but also fo r improvement in arterial elasticity. Further clinical research is sti ll needed to provide more reasonable approaches to patients with hyper tension.