Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
Section on Cardiology, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Curr Hypertens Rep. 2017 Sep 19;19(10):79. doi: 10.1007/s11906-017-0777-3.
It is widely accepted that successful lowering of blood pressure (BP) in patients with hypertension leads to regression of left ventricular hypertrophy (LVH). However, whether differences exist among pharmacological BP-lowering therapies is debated. In this report, we discuss these differences in light of recent literature and the position of extant practice guidelines.
Studies comparing the effects of antihypertensive classes on LVH regression reached different conclusions, but the overall direction which is reflected in current society guidelines is that successful lowering of BP is more important than selection of an individual antihypertensive class. Nevertheless, some practice guidelines added statements about considering a specific antihypertensive class for its potential benefit such as angiotensin-converting enzyme inhibitors and/or excluding a class such as direct vasodilators. On the other hand, reports have been consistent about the more favorable effect of intensive BP-lowering strategy (target systolic BP < 120 mmHg) compared to standard BP lowering (target systolic BP > 140 mmHg), which is not yet discussed in the current practice guidelines. Successful lowering of BP leads to LVH regression. While reports have been inconsistent about differences among antihypertensive classes, lowering BP beyond currently recommended levels has consistently showed a greater effect on LVH regression.
广泛认为成功降低高血压患者的血压可导致左心室肥厚（LVH）的消退。然而，降压药物治疗之间是否存在差异仍存在争议。在本报告中，我们根据最近的文献和现有的实践指南来讨论这些差异。
比较不同降压类别的药物对 LVH 消退影响的研究得出了不同的结论，但目前社会指南所反映的总体方向是成功降压比选择特定的降压药物类别更重要。然而，一些实践指南增加了关于考虑特定降压药物类别的陈述，例如血管紧张素转换酶抑制剂和/或排除某些药物类别，如直接血管扩张剂。另一方面，有报告一致表明，与标准降压（目标收缩压> 140mmHg）相比，强化降压策略（目标收缩压< 120mmHg）的效果更好，但这尚未在当前的实践指南中讨论。成功降压可导致 LVH 消退。虽然报告对降压药物类别之间的差异不一致，但降压超过目前推荐水平对 LVH 消退的影响一直更大。
