Left ventricular and microvascular hypertrophy in essential hypertension: clinical relevance and prognostic implications.

A considerable number of patients with essential hypertension develop cardiac and vascular structural and functional alterations, indicating an adaptation to the persistently elevated blood pressure. Besides the mechanical stress, neuro-humoral stimuli and possibly the genetic disposition contribute to the process of cardiovascular hypertrophy and remodeling. Left ventricular hypertrophy has been identified as an independent risk factor for cardiovascular events and mortality in these patients and therefore regression of cardiac hypertrophy seems to be a meaningful therapeutic goal. A normalization of myocardial hypertrophy can be achieved with various antihypertensive drugs and combinations, where angiotensin-converting enzyme inhibitors seem to be the most powerful substances. This observation emphasizes the role of the renin-angiotensin-aldosterone system in cardiac diseases. Morphological changes in small resistance arteries do not only represent an adaptation to an elevated peripheral resistance, moreover, they contribute to the persistence of the increase in blood pressure. Investigations on the potential reversibility of small vessel alterations in humans as well as the association with regression of left ventricular hypertrophy will be discussed in this review.