Reversal of left ventricular hypertrophy by antihypertensive therapy

Abstract

The effect of antihypertensive therapy on left ventricular hypertrophy due to essential hypertension was determined echocardiographicallv in 27 previously untreated subjects with essential hypertension. Fifteen were treated with hydrochlorothiazide alone, while 12 received additional therapy with methyldopa to control blood pressure. After a mean treatment interval of 11 months, mean blood pressure had fallen from 167/109 to 138/94 mm Hg ( P < 0.001). Simultaneously, echocardiographic left ventricular posterior wall thickness fell from 11 to 10 cm ( P < 0.07) and septal thickness fell from 1.3 to 1.2 cm ( P < 0.05). End-diastolic relative wall thickness, an index of concentric hypertrophy, fell from 0.50 to 0.45 ( P < 0.01, normal mean value = 0.33 ± 0.06). Estimated endsystolic left ventricular wall stress was normal both before and after treatment. No significant differences were demonstrable between the two treatment subgroups. We conclude that, in asymptomatic essential hypertension, treatment with diuretic or diuretic plus methyldopa can result in nearly complete reversal of left ventricular hypertrophy, provided that good blood pressure control is obtained.