Heart and vessel hypertrophy in hypertension: possibilities of regression.

Fifty-two middle-aged hypertensive males with left ventricular hypertrophy, diagnosed by echocardiography, were divided into two groups; 30 of them were treated with beta-blockers and 22 with methyldopa. Where blood pressure was insufficiently controlled, diuretics and, eventually vasodilating agents, were added to both treatment regimes. During 2 years of follow-up, blood pressure decreased significantly. The greatest decrease was observed during the first 3 months. Echocardiography revealed the greatest decrease in posterior wall and interventricular septal thickness also during the first 3 months. Posterior wall hypertrophy was reversed completely in the next 3 months, while further regression of interventricular septal hypertrophy was continuous during the remaining follow-up period. Left ventricular hypertrophy was reversed completely in 27 (51.9%) probands and remained unchanged in two patients. The regression was incomplete in 23 (44.2%) patients who were more obese and whose left ventricular hypertrophy was initially more pronounced. Regression of hypertrophy was not associated with a deterioration in left ventricular function and was achieved even after the addition of vasodilating drugs. No differences were observed between the treatment groups. The pathogenesis of left ventricular hypertrophy still remains unclear. After 2 years, no changes in peripheral vascular resistance in the forearm were observed at reactive hyperaemia. These results indicate that there might be a delay in the regression of vessel hypertrophy compared with that of the left ventricle.