Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje", Heroja Milana Tepica 1, Belgrade, 11000, Serbia.
Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Viale della Resistenza 23, 20036, Meda, Italy.
J Cardiovasc Transl Res. 2021 Feb;14(1):125-128. doi: 10.1007/s12265-020-09970-x. Epub 2020 Feb 21.
There is no consensus regarding the benefit of antihypertensive therapy on left ventricular structure and function. The most of studies investigated the effect of therapy on left ventricular hypertrophy, less studies were focused on left ventricular diastolic dysfunction and the minority on left ventricular mechanics. The majority of investigations showed positive effect of antihypertensive therapy on regression of left ventricular remodeling. Nevertheless, it is very difficult to distinguish the effect of antihypertensive medication from the effect of blood pressure reduction on left ventricular improvement. The other important issue in these studies is difficulty to distinguish the effect of left ventricular hypertrophy regression from the effect of antihypertensive medications on left ventricular diastolic function and mechanics. The novel findings suggest that the cascade of left ventricular remodeling in hypertensive heart disease begins with mechanical changes, continuous with diastolic dysfunction, and ends with left ventricular hypertrophy. This is very important paradigm because it enables early and timely diagnosis of subclinical left ventricular damage in hypertensive patients and should provide rapid detection of left ventricular function improvement during antihypertensive therapy.
关于抗高血压治疗对左心室结构和功能的益处，目前尚无共识。大多数研究都在探讨治疗对左心室肥厚的影响，较少的研究关注左心室舒张功能，而少数研究则关注左心室力学。大多数研究都表明抗高血压治疗对左心室重构的逆有积极作用。然而，要区分抗高血压药物治疗对左心室改善的影响与血压降低的影响是非常困难的。这些研究中的另一个重要问题是，难以区分左心室肥厚逆的影响与抗高血压药物对左心室舒张功能和力学的影响。新的发现表明，高血压性心脏病左心室重构的级联反应始于机械变化，继之以舒张功能障碍，最后导致左心室肥厚。这是一个非常重要的概念，因为它能够在高血压患者中早期及时诊断亚临床左心室损伤，并应在抗高血压治疗期间快速检测到左心室功能的改善。
