Existing users Log In New users Sign up

Regression of the Left Ventricular Hypertrophy in Patients with Essential Hypertension on Standard Drug Therapy

DISCOVERIES (ISSN 2359-7232), 2020, July-September issue


Ahmed SN, Jhaj R, Sadasivam B, Joshi RRegression of the Left Ventricular Hypertrophy in Patients with Essential Hypertension on Standard Drug Therapy. Discoveries 2020, 8(3): e115. DOI: 10.15190/d.2020.12

Submitted: August 3, 2020; Revision: September 4, 2020; Accepted: September 10, 2020; Published: September 30, 2020; 

 GO BACK to 2020, July-September issue


Regression of the Left Ventricular Hypertrophy in Patients with Essential Hypertension on Standard Drug Therapy

Shah Newaz Ahmed (1, *), Ratinder Jhaj (1), Balakrishnan Sadasivam (1), Rajnish Joshi (2)

(1) Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Madhya Pradesh, India

(2) Department of General Medicine, All India Institute of Medical Sciences Bhopal, Madhya Pradesh, India

*Corresponding author: Dr Shah Newaz Ahmed, Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India; Phone: 91-9903857789; Email: shahnewazpharmacology@gmail.com


Purpose: The American College of Cardiology/ American Heart Association 2017 and European Society of Cardiology/European Society of Hypertension 2018 guidelines were a paradigm shift in hypertension management in contemporary medicine. Lowering of blood pressure to less than 130 (systolic) and 80 (diastolic) mm of Hg irrespective of cardiovascular risk is recommended. While intensive blood pressure control is commonly achievable with rational pharmacotherapy, the magnitude of left ventricular hypertrophy regression is an independent factor in improvement in cardiovascular health. The regression of left ventricular hypertrophy has been adjudged as a clinically useful surrogate marker that reflects the efficacy of hypertension treatment. Though angiotensin converting enzyme inhibitors/ angiotensin receptor blockers (ACEI/ARB) are the preferred initial drug for greater regression of left ventricular mass, the choice of add-on therapy, if required, is still debatable. Therefore, in our observational study, we sought to compare the reduction in left ventricular mass index in hypertensives with left ventricular hypertrophy on standard ACEI/ARB based drug therapy.

Materials and Methods: The cohort (n=217) comprised of patients with uncontrolled hypertension (blood pressure>140/90 mm of Hg) and left ventricular hypertrophy (left ventricular mass index>115 and 95 gram/square meter in males and females respectively). The add-on drug in ACEI/ARB therapy was either thiazide diuretics (TD) or calcium channel blockers (CCB). Four sub-cohorts were constituted: mono-therapy - group A (n=70, ACEI/ARB), dual-therapy - group B (n=48, ACEI/ARB+TD) and  group C (n=51, ACEI/ ARB+CCB), triple therapy - group D (n=48, ACEI/ ARB+TD+CCB). Left ventricular mass index was determined using echocardiography at baseline and after 24 weeks of therapy.

Results: There was no significant difference in baseline clinical or demographic variables between group B and group C. Baseline blood pressure and duration of hypertension was greater in group D compared to group A (P<0.001). The reduction in left ventricular mass index (mean ±SD) in the four groups (A to D) was 16.7±18.7, 21.0±20.8, 20.5±15.5  and 29.1±21.5 g/m2  respectively (D>A, P=0.011, B versus C, P=1.00). The corresponding change in blood pressure (systolic/diastolic) was 18.5±13.6/8.9±11.2, 27.5±19.2/12.2±9.3, 23.4±16.7/ 5.4±10.1, 26.6±19.5/10.7±12.8 mm of Hg respectively (systolic, B>A, P=0.027, D>A, P=0.048) (diastolic, B>C, P=0.013).

Conclusion: Anti-hypertensive treatment with angiotensin converting enzyme inhibitors/angiotensin receptor blockers-based therapy produced graded regression of left ventricular hypertrophy with monotherapy, dual therapy and triple therapy.  In dual therapy, add-on of either thiazide diuretics or calcium channel blockers to angiotensin converting enzyme inhibitors/angiotensin receptor blockers showed equal efficacy in regression of left ventricular hypertrophy independent of blood pressure reduction.

Access full text of the manuscript here: 


1. Kahan T, Bergfeldt L. Left ventricular hypertrophy in hypertension: its arrhythmogenic potential. Heart 2005;91:250–6. 
2. Cuspidi C, Sala C, Negri F, Mancia G, Morganti A. Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies. J. Hum. Hypertens. 2012;26:343–9. 
3. Levy D, Anderson KM, SAVAGE DD, KANNEL WB, CHRISTIANSEN JC, CASTELLI WP. Echocardiographically Detected Left Ventricular Hypertrophy: Prevalence and Risk Factors. Ann. Intern. Med. 1988;108:7. 
4. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N. Engl. J. Med. 1990;322:1561–6. 
5. Five-year findings of the Hypertension Detection and Follow-up Program. Prevention and reversal of left ventricular hypertrophy with antihypertensive drug therapy. Hypertension Detection and Follow-up Program Cooperative Group. Hypertens. Dallas Tex 1979 1985;7:105–12. 
6. Prineas RJ, Rautaharju PM, Grandits G, Crow R, MRFIT Research Group. Independent risk for cardiovascular disease predicted by modified continuous score electrocardiographic criteria for 6-year incidence and regression of left ventricular hypertrophy among clinically disease free men: 16-year follow-up for the multiple risk factor intervention trial. J. Electrocardiol. 2001;34:91–101. 
7. Levy D, Salomon M, D’Agostino RB, Belanger AJ, Kannel WB. Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. Circulation 1994;90:1786–93. 
8. Mathew J, Sleight P, Lonn E, Johnstone D, Pogue J, Yi Q, et al. Reduction of cardiovascular risk by regression of electrocardiographic markers of left ventricular hypertrophy by the angiotensin-converting enzyme inhibitor ramipril. Circulation 2001;104:1615–21. 
9. Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Nieminen MS, et al. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major cardiovascular events. JAMA 2004;292:2343–9. 
10. Cuspidi C, Esposito A, Negri F, Sala C, Masaidi M, Giudici V, et al. Studies on left ventricular hypertrophy regression in arterial hypertension: a clear message for the clinician? Am. J. Hypertens. 2008;21:458–63. 
11. Soliman EZ, Byington RP, Bigger JT, Evans G, Okin PM, Jr DCG, et al. HHS Public Access. Eff. Intensive Blood Press. Low. Left Ventricular Hypertrophy Patients Diabetes Action Control Cardiovasc. Risk Diabetes ACCORD Blood Press. Trial 2016;66:1123–9. 
12. Gaudio C, Ferri FM, Giovannini M, Pannarale G, Puddu PE, Vittore A, et al. Comparative Effects of Irbesartan Versus Amlodipine on Left Ventricular Mass Index in Hypertensive Patients with Left Ventricular Hypertrophy: J. Cardiovasc. Pharmacol. 2003;42:622–8. 
13. Devereux RB, Palmieri V, Sharpe N, De Quattro V, Bella JN, de Simone G et al. Effects of Once-Daily Angiotensin-Converting Enzyme Inhibition and Calcium Channel Blockade-Based Antihypertensive Treatment Regimens on Left Ventricular Hypertrophy and Diastolic Filling in Hypertension: The Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement (PRESERVE) Trial. Circulation 2001;104:1248–54. 
14. Yasunari K, Maeda K, Watanabe T, Nakamura M, Yoshikawa J, Asada A. Comparative effects of valsartan versus amlodipine on left ventricular mass and reactive oxygen species formation by monocytes in hypertensive patients with left ventricular hypertrophy. J. Am. Coll. Cardiol. 2004;43:2116–23. 
15. Misra KH. Effect of Telmisartan on the Regression of the Left Ventricular Hypertrophy in the Patients of essential hypertension. J. Clin. Diagn. Res. 2013 [cited 2019 Mar 23]; Available from:http://www.jcdr.net/article_fulltext.asp?issn= 0973-709x&year=2013&month=July&volume= 7&issue=7&page=1352-1355&id=3127
16. Moroni C, Tolone S, Lopreiato F, Scrofani AR, Bossini A, Affricano C, et al. Effects of losartan on left ventricular mass: a three-year follow-up in elderly hypertensives with myocardial hypertrophy despite successful conventional antihypertensive treatment. Eur. Rev. Med. Pharmacol. Sci. 2017;21:1323–8. 
17. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur. Heart J. 2018;39:3021–104. 
18. Reboussin DM, Allen NB, Griswold ME, Guallar E, Hong Y, Lackland DT, et al. Systematic Review for 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: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertens. Dallas Tex 1979 2018;71:e116–35. 
19. JNC8 Guidelines for the Management of Hypertension in Adults - Practice Guidelines - American Family Physician. [cited 2019 Mar 31]; Available from: https://www.aafp.org/afp/2014/1001/p503.html
20. Cunningham JB, McCrum-Gardner E. Power, effect and sample size using GPower: practical issues for researchers and members of research ethics committees. Evid.-Based Midwifery 2007 [cited 2019 Jun 7]; Available from: http://link.galegroup.com/apps/doc/A172050741/AONE?sid=googlescholar
21. Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 1977;55:613–8. 
22. Du Bois D, Du Bois EF. A formula to estimate the approximate surface area if height and weight be known. 1916. Nutr. Burbank Los Angel. Cty. Calif 1989;5:303–11 (discussion 312-313). 
23. Schmieder RE, Martus P, Klingbeil A. Reversal of left ventricular hypertrophy in essential hypertension. A meta-analysis of randomized double-blind studies. JAMA 1996;275:1507–13. 
24. Jennings G, Wong J. Regression of left ventricular hypertrophy in hypertension: changing patterns with successive meta-analyses. J. Hypertens. Suppl. Off. J. Int. Soc. Hypertens. 1998;16:S29-34. 
25. Okura T, Miyoshi K, Irita J, Enomoto D, Jotoku M, Nagao T, et al. Comparison of the effect of combination therapy with an angiotensin II receptor blocker and either a low-dose diuretic or calcium channel blocker on cardiac hypertrophy in patients with hypertension. Clin. Exp. Hypertens. N. Y. N 1993 2013;35:563–9. 
26. Boydak B, Nalbantgil S, Yilmaz H, Zoghi M, Ozerkan F, Nalbantgil I, et al. The effect of combination therapy on regression of left ventricular hypertrophy in cases with hypertension. Saudi Med. J. 2004;25:1975–8. 
27. Reichek N, Devereux RB, Rocha RA, Hilkert R, Hall D, Purkayastha D, et al. Magnetic Resonance Imaging Left Ventricular Mass Reduction With Fixed-Dose Angiotensin-Converting Enzyme Inhibitor–Based Regimens in Patients With High-Risk Hypertension. Hypertension 2009;54:731–7. 
28. Chobanian et al. - 2003 - Seventh Report of the Joint National Committee on .pdf. 
29. Carey RM, Whelton PK, for the 2017 ACC/AHA Hypertension Guideline Writing Committee. Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline. Ann. Intern. Med. 2018;168:351. 
30. Dahlöf B, Gosse P, Guéret P, Dubourg O, de Simone G, Schmieder R, et al. Perindopril/indapamide combination more effective than enalapril in reducing blood pressure and left ventricular mass: the PICXEL study. J. Hypertens. 2005;23:2063–70. 
31. Neutel JM, Smith DHG, Weber MA. Effect of Antihypertensive Monotherapy and Combination Therapy on Arterial Distensibility and Left Ventricular Mass. Am J Hypertens. 2004 Jan 1;17(1):37–42. 
32. Soliman EZ, Ambrosius WT, Cushman WC, et al. Effect of intensive blood pressure lowering on left ventricular hypertrophy in patients with hypertension: the systolic blood pressure intervention (SPRINT) trial. Circulation. 2017;136:440–50
33. Ahmed SN, Jhaj R, Sadasivam B, et al. The role of renin–angiotensin–aldosterone system inhibition in the regression of hypertensive left ventricular hypertrophy: the evidence of the last three decades. Drugs Ther Perspect. 2020; https://doi.org/10.1007/s40267-020-00769-z
34. Berkelmans GF, Visseren FL, Jaspers NE, et al. SPRINT trial: it’s not just the blood pressure! Eur J Prev Cardiol. 2017;24:1482–4.
35. Jekell A, Nilsson PM, Kahan T. Treatment of Hypertensive Left Ventricular Hypertrophy. Curr Pharm Des. 2018;24(37):4391-4396.
36. Benson K, Hartz AJ. A comparison of observational studies and randomized, controlled trials. N. Engl. J. Med. 2000;342:1878–86. 
37. Hróbjartsson A, Thomsen ASS, Emanuelsson F, Tendal B, Hilden J, Boutron I, et al. Observer bias in randomized clinical trials with measurement scale outcomes: a systematic review of trials with both blinded and nonblinded assessors. CMAJ Can. Med. Assoc. J. J. Assoc. Medicale Can. 2013;185:E201-211. 
38. Concato J, Shah N, Horwitz RI. Randomized, Controlled Trials, Observational Studies, and the Hierarchy of Research Designs. N. Engl. J. Med. 2000;342:1887–92. 
39. Dadlani A, Madan K, Sawhney JPS. Ambulatory blood pressure monitoring in clinical practice. Indian Heart J. 2019;71:91–7. 
40. de Vries SO, Heesen WF, Beltman FW, Kroese AH, May JF, Smit AJ, et al. Prediction of the left ventricular mass from the electrocardiogram in systemic hypertension. Am. J. Cardiol. 1996;77:974–8. 
41. Mahn JJ, Dubey E, Brody A, Welch R, Zalenski R, Flack JM, et al. Test characteristics of electrocardiography for detection of left ventricular hypertrophy in asymptomatic emergency department patients with hypertension. Acad. Emerg. Med. Off. J. Soc. Acad. Emerg. Med. 2014;21:996–1002. 
42. Fuchs FD, DiNicolantonio JJ. Angiotensin receptor blockers for prevention of cardiovascular disease: where does the evidence stand? Open Heart. 2015 Apr 10;2(1):e000236.

News & Events Latest news from Discoveries

  • 2022, April| AWARDS!

    2022 Discoveries Award winning articles!

    - Kinal Bhatt et al. 2021 (Larking Health System, FL, USA); Bhatt K, Agolli A, Patel MH, et al. High mortality co-infections of COVID-19 patients: mucormycosis and other fungal infections. Discoveries. 2021;9(1):e126. 
    27 citations in the past 1 year - $1000 prize

    - Hasnain Jan et al. 2020 (Quaid-i-Azam University, Pakistan); Jan H, Faisal S, Khan A, et al. COVID-19: Review of Epidemiology and Potential Treatments Against 2019 Novel Coronavirus. Discoveries. 2020;8(2):e108. 
    23 citations in the past 2 years - $400 prize

    Congratulations! Prizes will be received by the awardees in July 2022!

  • 2021, July| 2021, Jul-September

    Due to the high volume of the submitted articles, both Discoveries and Discoveries Reports are experiencing processing and publication delays during the months of July-September 2021. We will get back to the normal processing and publication times starting in October 2021. Note that our editorial and administrativ work is fully funded by our publishing house at this time and we are striving to KEEP THE NO FEE/NO CHARGE strategy in place as long as possible. 

  • 2021, January| AWARDS!

    2022 DISCOVERIES AWARDS! Discoveries will offer $1000 and $400 awards in early 2022, for the most cited (2021 ISI Citations) and visible articles published in 2018-2021.

  • 2020, November| Follow us on Twitter!

    You can now follow the latest Discoveries news and updates on Twitter! (@DiscoveriesNews) 

  • 2020, August| For Authors!

    Due to a high volume of article submissions, our peer-review process takes more than usual. The pre-screening decision is released in 1-2 days, while the peer-review process lasts between 10 and 20 days.  

  • 2020, April | For Authors!

    WE DO NOT TOLERATE ANY MISCONDUCT! Please be aware that we are testing all received articles with specialized software for PLAGIARISM and WE WILL TAKE MEASURES if your article is already published or in consideration for publication by other journals! This may result in serious professional consequences for the authors. The latest striking case is the following article which is already published and was re-submitted here.  

  • 2020, April | For Authors!

    We are happy to let you know that all articles published in Discoveries are now included in PubMedCentral (PMC). New accepted articles will be included in PMC and PubMed within 1-2 weeks after their publication.

  • 2020, January | For Authors!

    Starting in January 2020, Discoveries will also consider articles submitted by Discoveries' Editorial Board members. However, only a small number of such articles (maximum 4 articles/year) will be considered for publication after the peer-review process, and the authors who are also our editors will be clearly disclosed on our website.  

  • 2019, September | Indexed by PMC

    Discoveries is now indexed by PubMedCentral and Pubmed. The agreement with US National Library of Medicine was signed on September 10, 2019. Our next step is ISI Web of Science indexing. NOTE: previously published articles will be included on PubMed in early 2020.

  • 2019, September | PubMed inclusion!

    We are happy to let you know that Discoveries successfuly passed the last step (Technical Review) required for PubMedCentral and PubMed inclusion!

  • 2019, July | PubMed inclusion News!

    We are happy to receive positive comments from PMC/NLM-NIH regarding Discoveries' last step (Technical Review) required for PubMedCentral and PubMed inclusion. We will let you know once whole indexing process is completed. 

  • 2019| Sharing and Distribution!

    All articles published in Discoveries are Open Access articles distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited and it is not used for commercial purposes.

  • 2018-2019 | For Authors!

    From now on and for at least 1 year, we will only accept articles from authors that are NOT members of Discoveries' Editorial Board. All articles submitted by our editors will be immediately rejected until further notice (one accepted article was already rejected). 

  • 2018 | PubMed inclusion News!

    Discoveries successfully passed the Scientific Quality Review by NLM-NIH for PubMedCentral and PubMed indexing. This is the first and the most important step towards PubMedCentral and PubMed indexing! The second (last) step is the Technical Review.

  • 2016, April | Faster Peer-Review

    Starting on April 13th 2016, all articles selected for a peer-review will receive the post peer-review decision within ~10 days. The initial pre-screening time will remain the same (48h from the submission of the manuscript). This decision will significantly accelerate the publication, with no effect on the quality of the peer-review process.

  • 2016, February | Manuscript submission

    Discoveries is commited to excellence, quality and high editorial standards. We are receiving an increasing number of manuscripts for which the identity of the authors/corresponding author can't be verified. Please NOTE that ALL these articles were and will be immediately REJECTED. Indicating an institutional email address is the easiest way to overcome this problem! Moreover, we do not accept any pressure on our editorial board to accept a manuscript. This results in a prompt rejection of the article.

    Editorial Policies
  • 2016, January | Main Objective

    After reaching all proposed milestones until now (including being indexed by Google Scholar in 2014), Discoveries' next Aim is PubMed indexing of all its articles (already published and upcoming). There will be no charge for the submission or publication of articles before Discoveries is indexed.

  • 2015, August | Discoveries - on PubMed

    We are happy to announce that our first Discoveries articles were included in PMC and PubMed. More articles (submitted by NIH funded authors) are now processed for being included.

    Discoveries articles now on PubMed
  • 2015, April | Special Issue

    DISCOVERIES published the SPECIAL ISSUE entitled "INFLAMMATION BETWEEN DEFENSE AND DISEASE: Impact on Tissue Repair and Chronic Sickness".

    Special Issue on "Inflammation"
  • 2015 | Ischemia Collection

    DISCOVERIES launched a call for papers for a Collection of Articles with focus on "ISCHEMIA". If you are interested to submit a manuscript, please contact us at info@discoveriesjournals.org

  • 2014, September | Special Issue

    DISCOVERIES just publish the SPECIAL ISSUE entitled "CELL SECRETION & MEMBRANE FUSION" in September 2014. Initially scheduled for publication between October 2014-March 2015, this issue was successfully published earlier than scheduled. 

    Special Issue
  • 2014, April | Indexed by Google Scholar

    All our published articles are now indexed by Google Scholar! First citations to Discoveries articles are included! Search for the article's title (recommended) or the authors:

    Google Scholar Search
  • 2014 | DISCOVERIES

    DOIs (Digital Object Identifiers) are now assigned to all our published manuscripts in Discoveries. DOI uniquely identifies an article and is provided by CrossRef.

  • 2013, July | Manuscript Submission

    Submit your manuscript FREE, FAST and EASY ! (in less than 1 minute)! There are NO fees for the manuscript submission or publishing of the accepted manuscripts.
    read more

  • 2013, July | DISCOVERIES

    We are now ACCEPTING MANUSCRIPTS for publishing in DISCOVERIES. We aim publishing a small number of high impact experimental articles & reviews (around 40/year) to maintain a high impact factor. Domains of interest: all areas related to Medicine, Biology and Chemistry ...

    read more
Member Login
Free Registration Click here to sign up
Copyright © 2013 Applied Systems. All Rights Reserved.