Is severe left ventricular hypertrophy (LVH) reversible?

From the Guidelines

Severe left ventricular hypertrophy (LVH) is reversible with appropriate treatment, as evidenced by a 13.3% reduction in LVM with angiotensin-converting enzyme inhibitors, according to a meta-analysis of 39 trials of antihypertensive therapy 1. The reversibility of severe LVH depends on several factors, including the underlying cause, duration of hypertrophy, and treatment approach. Key factors to consider in the treatment of severe LVH include:

• The primary treatment focuses on addressing the underlying cause, most commonly hypertension, which typically involves antihypertensive medications such as ACE inhibitors or angiotensin receptor blockers, as these have been shown to be effective in reducing LVM 1.
• The choice of antihypertensive agent can impact the degree of LVH regression, with angiotensin-converting enzyme inhibitors being the most effective agents in reducing LVM, followed by calcium channel blockers, diuretics, and beta-blockers 1.
• Regression of LVH typically occurs gradually over months to years with consistent treatment, and controlling blood pressure reduces the mechanical stress on the heart, allowing the thickened heart muscle to gradually remodel and return toward normal thickness.
• However, if LVH has been present for many years or if there is significant fibrosis (scarring) of the heart muscle, complete reversal may not be possible, though partial improvement can still occur with appropriate treatment. Some of the key treatment options for severe LVH include:
• ACE inhibitors, such as lisinopril 10-40 mg daily
• Angiotensin receptor blockers, such as losartan 50-100 mg daily
• Calcium channel blockers, such as amlodipine 5-10 mg daily
• Beta-blockers, such as metoprolol 25-200 mg daily, for LVH caused by hypertrophic cardiomyopathy. It is essential to note that the treatment approach should be individualized based on the underlying cause of LVH and the patient's specific needs, and that the goal of treatment is to reduce blood pressure and alleviate the mechanical stress on the heart, allowing for the reversal of LVH 1.

From the Research

Reversibility of Severe LVH

• Severe left ventricular hypertrophy (LVH) can be reversible with appropriate treatment, as evidenced by various studies 2, 3, 4, 5.
• Antihypertensive therapies, such as combination therapy, angiotensin converting enzyme (ACE) inhibitors, and methyldopa, have been shown to be effective in reversing LVH 2.
• Calcium channel blockers have also been found to reduce LVH and improve left ventricular filling 3.
• Intensive blood pressure lowering (systolic BP < 120 mmHg) has been shown to induce greater regression of electrocardiographic LVH than standard BP targets 4.
• The optimal agents for inducing LVH regression include renin-angiotensinogen-aldosterone system inhibitors and calcium channel blockers, although recent meta-analyses have demonstrated superior efficacy of non-hydrochlorothiazide diuretics 4.

Factors Influencing Reversibility

• The degree of fall in blood pressure and duration of therapy do not appear to be the primary factors influencing the reversibility of LVH, as different therapies have been shown to have varying effects on LVH independent of these factors 2.
• The underlying cause of LVH, such as systemic hypertension or athletic's heart, can influence the reversibility of LVH and the most effective treatment approach 6.
• Lifestyle changes and medications, such as ACE inhibitors and calcium channel blockers, can help to prevent and regress LVH, and are important components of treatment 5.