ABSTRACT
Introduction Left ventricular hypertrophy (LVH) significantly increases the risk of cardiovascular morbidity and mortality in hypertensive and non-hypertensive populations, independent of blood pressure (BP), in either population with or without cardiovascular disease. Indeed, it is the most potent prognostic marker beside advanced age. The incidence of hypertension increases with ageing, and ageing aggravates hypertensive changes. The mechanisms that underlie this risk are increasingly understood. Impairments in coronary circulation and thus reduced myocardial perfusion leading to ventricular fibrosis and impaired myocardial contractile function, and disturbances in cardiac electrophysiology contribute to such increased risk in LVH. Owing to its strong prognostic significance of LVH, normalization or regression of LV mass has emerged as one of the desirable goals of antihypertensive treatment. Indeed, prospective evidence is accumulating indicating that reduction in LV mass is associated with lower cardiovascular complications. Many studies have been published suggesting that regression is achievable using a variety of antihypertensive classes. The question remains whether certain agents or class of agents are more superior than the other to reduce LV mass and whether such agents are able to do so beyond that which can be achieved by its BP lowering effect.
