Regression of structural alterations in hypertension.

Morbidity and mortality are higher in hypertensive patients who have already developed cardiovascular complications. Several prospective epidemiological and clinical studies have indicated that regression of cardiovascular alterations, preferably when still at an initial stage, is a desirable goal in the treatment of hypertension. Clinical assessment of cardiac hypertrophy may be precisely obtained with echocardiography. Structural vascular changes may be evaluated indirectly in man by measuring minimal vascular resistance from maximal blood flow and arterial pressure. The results of a large number of studies have indicated that in hypertensive patients a significant regression of cardiovascular structural changes may be obtained with several antihypertensive drugs, but they have not yet established whether a complete "normalization" may be really obtained. Further studies are needed to identify factors that modulate regression of cardiac and vascular smooth muscle hypertrophy. Most important, it still remains to be clarified whether regression of cardiovascular structural changes in hypertensives significantly improves prognosis per se independently from blood pressure reduction.