Invited review
Hypertensive heart disease: left ventricular hypertrophy

Left ventricular (LV) hypertrophy (LVH) is target-organ-damage, a form of preclinical disease induced by volume and pressure overload, genetic factors and other stimuli. Over the last 20 years it has become clear that it is possible to assess LVH with increasing accuracy with echocardiographic and magnetic resonance methods. Both LVH per se but also the geometry has been shown to be important in understanding the basic pathology of the organ-damage as well predictive value regarding cardiovascular morbidity and mortality. In addition, systematic antihypertensive treatment does in fact reduce LVH, in fact 1 year of antihypertensive treatment resulted in 15 g/m² reduction in LV mass index. Furthermore, it has been shown that the resultant reduction in LV mass translates into reduction into cardiovascular morbidity and mortality which is statistical independent of the blood pressure per se. One standard deviation reduction in LV mass (25.3 g/m²) resulted in 38% reduction of cardiovascular mortality. Left ventricular functional parameters are also affected by hypertensive disease. Left ventricular systolic function measured at the endocardial level appears supranormal when in fact it the myocardial contractility can be reduced. Antihypertensive treatment does reverse LV systolic function significantly even in patients preserved ejection fraction. In addition, improving LV systolic function does have prognostic significance. Left ventricular diastolic function is also very commonly affected in hypertensive disease. Even though we report significant improvement in transmitral flow parameters as bioassays for LV diastolic function this does in our cohorts translate into improvement in cardiovascular morbidity and mortality. This might be due to low power. Thus, clinicians should focus on blood pressure reduction, finding LVH, reducing LVH and improving LV systolic function even in conditions with preserved LV ejection fraction as these factors contribute to increased cardiovascular morbidity and mortality. Improvement of these factors results in significant improvement in outcome.