In
essential hypertension, ventricular function is determined primarily by the degree of
hypertrophy (myocardial factor) and by the organic complications in the coronary artery (coronary factor). Ventricular function is inversely correlated with ventricular size and systolic wall stress, inasmuch as ventricular function diminishes when these two variables increase. Coronary reserve is reduced even in hypertensive
hypertrophy without evidence of
coronary artery disease. MVO2 per mass unit is directly correlated with systolic wall stress per cross-sectional area of the left ventricular wall. It is concluded that the appropriateness of
left ventricular hypertrophy, as a result of mass-to-volume ratio and stress, is a major determinant of left ventricular performance, of coronary blood flow, and of myocardial oxygen consumption. Pharmacotherapeutical means of reversing
cardiac hypertrophy (
prazosin,
clonidine,
enalapril, and
nifedipine) were analyzed in concentrically, as well as eccentrically, hypertrophied left ventricles. Regression of
cardiac hypertrophy, i.e., therapeutic intervention on a critical precursor of hypertensive
congestive heart failure, can be obtained by various
antihypertensive agents.
Prazosin,
calcium channel blockers, and
angiotensin converting enzyme inhibitors as well as a combined treatment regimen using alpha-receptor blockers together with
diuretics and
vasodilators can all induce regression of
hypertrophy associated with an improvement in left ventricular function. Moreover, an improved coronary reserve may reduce the ischemic risk of the hypertrophied myocardium. However, not all
antihypertensive drugs seem equally effective in bringing about coronary regression of
left ventricular hypertrophy (LVH). No regression or little regression has been found with
diuretic monotherapy despite a satisfactory reduction in blood pressure. On the other hand, a trend towards a regression has been observed in patients in whom treatment with
clonidine significantly reduced
catecholamines. Recent experimental data in spontaneously hypertensive rats indicate that the impaired coronary reserve can be significantly improved by the long-term administration of blood pressure lowering agents, e.g., by
nifedipine or by the combination of
metoprolol plus
hydralazine.