Pathophysiological considerations in left ventricular hypertrophy.

Considerable evidence is available to relate development of left ventricular hypertrophy to the maintenance and progression of hypertensive vascular disease and its associated hemodynamic changes that induce an increased left ventricular afterload. However, when critical investigators question in depth the variety of other nonhemodynamic factors that may also be associated with the development (or regression) of left ventricular hypertrophy, they are faced with three disquieting conclusions. First, knowledge of those mechanisms that account for the development and maintenance (or, for that matter, even regression) of left ventricular hypertrophy in hypertension is incomplete. Second, little is known as to how the physical hemodynamic and mechanical factors associated with the pathogenesis of hypertension are translated into the biochemical events associated with the development of cardiac muscle hypertrophy. Finally, to understand these important factors more clearly, the investigator (clinical or experimental) must design studies more precisely to control for the additional complicating, nonhemodynamic factors.