[Left ventricular remodeling in arterial hypertension and its therapy].

Left ventricular (LV) hypertensive remodeling has polymorphic character with broad spectrum of its geometry. Echocardiographically it is simply possible to distinguish 4 LV remodeling types: normal geometry, concentric remodeling, eccentric hypertrophy and concentric hypertrophy. In an overview article morphological, functional and prognostic characteristics of remodeled hypertensive LV are presented. Most adverse prognosis as regards cardiovascular (CV) morbidity and mortality is in LV concentric hypertrophy. As to the current knowledge LV hypertrophy regression can be considered for potential aim of the management of arterial hypertension, independent from blood pressure normalization. Removal of structural changes of the CV system due to arterial hypertension could be more important function of antihypertensive drugs than blood pressure reduction alone. Until now minimally 147 articles regarding the influence of antihypertensive treatment on LV hypertrophy regression have been published. According to them most effective drugs are angiotensin-converting enzyme inhibitors. A new idea has brought the HYCAR study, which has demonstrated, that low dose of ramipril without any antihypertensive effect significantly reduces LV hypertrophy. The results of the study "evoke" change in the management of arterial hypertension: the treatment with low dose of ramipril in indication of LV hypertrophy regression also in those hypertensive patients with formerly normalized blood pressure. The importance of LV hypertrophy regression for the prognosis must be however specified in large designed trials, because until now it is not exactly known.