Hypertension and the Heart(Hypertension : Pathophysiology and Treatment)

Various trials had been shown that the active treatment of hypertension reduced the rate of stroke, but not of coronary events. Recently, MRC trial showed that the coronary event rate was reduced in non-smokers taking propranolol. By the way, the left ventricular wall tension due to hypertension leads to striking structual, biochemical and physiological changes in the myocardium and develops LV hypertrophy. The LV hypertrophy helps to maintein left ventricular stroke volume, but dilatation of LV and eventually frank congestive heart failure may supervene. Heart failure may be attributed not only to only to the primary functional changes in the hypertrophied myocardium but also to the interraction of a number of facters. The interraction of coronary artery disease with hypertension is particularly important in the pathophysiology. However, concentric LV hypertrophy is not a permanent mechanism of compensation, because the hypertrophied heart cannot sustain the increased pressure load indefinitely and cardiac function will become impaired in the time course of cardiac hypertrophy. Consequently, a medical therapy will prevents the developement of LV hypertrophy or regress an already established LV hypertrophy equal to a causative treatment of hypertensive heart failure. A step-care of hypertensive heart disease should be considered through antihypertensive drugs, which can a) regress LV hypertrophy, b) increase myocardial perfusion and c) improve LV function depending on the stage of hypertensive heart disease