ABSTRACT
Elevated arterial pressure is a well-established pre-disposing factor for the development of stroke, hypertensive heart and peripheral artery disease, as well as for cardiac and renal failure. Hypertension-induced alterations in cardiac structure and function manifested as left ventricular hypertrophy (LVH) associated with impaired coronary hemodynamics and ventricular fibrosis accounting for this major risk factor of cardiovascular morbidity and mortality. lndeed, cardiac enlargement (or LVH) carries a greater risk than either height of systolic or diastolic pressure. Furthermore, a large body of evidence attests to the fact that LVH is a strong independent risk factor for heart failure, sudden death, ventricular dysrhythmias, and coronary artery disease. LVH usually begins as compensated hypertrophy, but it eventually progresses to cardiac failure if arterial pressure remains uncontrolled. However, the mechanisms underlying the increased risk associated with LVH have not completely elucidated, although it is likely that a number of factors may contribute. Since alI components of the heart seem to affected with LVH (e.g., muscle, vasculature and interstitium), impaired coronary hemodynamics, ventricular fibrosis and dysfunction, increased vulnerability to lethal dysrhythmias, and enhanced coronary atherogenesis might account for the risk. Several metaanalysis have shown that antihypertensive therapy has greater propensity to reduce stroke death than death from coronary heart disease, suggesting that arterial pressure may exert a greater effect on the cerebral circulation than the coronary. Moreover, this concept points to role of nonhemodynamic factors that participate in the development of hypertension related cardiovascular injury and, therefore, in this risk. Thus, current goals of antihypertensive therapy are to prevent or reverse these additional alterations along with optimal control of arterial pressure. This review focuses primarily on the strategy for pharmacological prevention and reversal of myocardial ischemia and ventricular fibrosis which are also associated with hypertensive heart disease.