What are the implications of left ventricular hypertrophy (LVH)?

From the Guidelines

Left ventricular hypertrophy (LVH) significantly increases the risk of arrhythmias, heart failure, and sudden cardiac death, making early intervention crucial to prevent these complications and improve long-term cardiac outcomes. The primary management of LVH focuses on treating the underlying cause, most commonly hypertension. According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, first-line treatment includes blood pressure control with medications such as ACE inhibitors (like lisinopril 10-40 mg daily), ARBs (such as losartan 25-100 mg daily), or calcium channel blockers (amlodipine 5-10 mg daily). These medications not only reduce blood pressure but can also promote regression of LVH.

Some key points to consider in the management of LVH include:

• Lifestyle modifications are essential, including sodium restriction (<2.3g daily), regular aerobic exercise (150 minutes weekly), weight management, and limiting alcohol consumption.
• For LVH caused by aortic stenosis, valve replacement may be necessary.
• In hypertrophic cardiomyopathy, beta-blockers (metoprolol 25-200 mg daily) or calcium channel blockers help manage symptoms.
• Regular monitoring with echocardiography every 1-2 years is recommended to assess progression or regression.
• The degree of hypertrophy does not appear to be directly associated with the severity of diastolic dysfunction and limiting symptoms, but extreme degrees of LVH can be linked to sudden events due to the potential impact on myocardial architecture, oxygen demand, coronary vascular resistance, and capillary density 1.
• Assessment of LVH by means of echocardiography or MRI is not universally recommended during evaluation and management of hypertension in adults, but it is most useful in adults who are young (≤18 years of age) or have evidence of secondary hypertension, chronic uncontrolled hypertension, or history of symptoms of HF 1.

Overall, the management of LVH should prioritize reducing the risk of cardiovascular complications and improving long-term cardiac outcomes, and should be guided by the most recent and highest quality evidence, such as the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline 1.

From the FDA Drug Label

Losartan is indicated to reduce the risk of stroke in patients with hypertension and left ventricular hypertrophy, Left Ventricular Hypertrophy (LVH) is an enlargement of the walls of the left chamber of the heart (the heart’s main pumping chamber) LVH can happen from several things. High blood pressure is the most common cause of LVH.

The implications of left ventricular hypertrophy (LVH) are an increased risk of:

• Stroke
• Cardiovascular events
• Cardiovascular mortality It is also associated with an enlargement of the walls of the left chamber of the heart, which can be caused by high blood pressure. 2

From the Research

Implications of Left Ventricular Hypertrophy (LVH)

The implications of LVH are significant and far-reaching. Some of the key implications include:

• Increased risk of cardiovascular disease risk, as LVH is a powerful independent indicator of cardiovascular disease risk 3
• Increased risk of subsequent cardiovascular morbidity and mortality from any cause 4
• Association with significant mortality and increased risk for developing nonfatal cardiovascular complications, including coronary heart disease 5
• Strong predictor of adverse cardiovascular events, particularly in hypertensive patients 6
• Increased risk of sudden death, acute myocardial infarction, and other cardiovascular morbidity 7

Therapeutic Implications

The therapeutic implications of LVH are also important to consider. Some of the key therapeutic implications include:

• The use of angiotensin-converting enzyme (ACE) inhibitors, which appear to perform better than other antihypertensive agents in reversing cardiac structural changes 3
• The use of angiotensin II type 1 receptor blockers (ARBs), which have been shown to be effective in reducing left ventricular mass and may have similar effects to ACE inhibitors 4
• The use of beta blockers, which may have a role in regressing LVH, although this role is minor compared to ACE inhibitors and ARBs 6
• The use of calcium channel blockers, which have been shown to reduce LVH and improve left ventricular filling 7

Key Factors

Some of the key factors that contribute to the implications of LVH include:

• The activation of the renin-angiotensin system, which plays an important role in the development of LVH 3, 4, 5
• The growth of cardiomyocytes and accumulation of extracellular matrix and fibrosis, which are partly induced by angiotensin II 4
• The correlation between biochemical markers and changes in left ventricular mass, which can be monitored by brain natriuretic peptide 4