Management of left ventricular hypertrophy in patients with renal failure.

Left ventricular hypertrophy (LVH) is considered to be a strong, blood pressure-independent cardiovascular risk factor in patients with primary and secondary hypertension. Clinical studies suggesting that regression of left ventricular hypertrophy is associated with improved cardiovascular prognosis have now been published. In patients with end-stage renal disease LVH is nor as homogeneous als in nonuremic individuals. Persistent pressure overload leads to an increase of left ventricular wall thickness on expenses of left ventricular diameter (concentric LVH), whereas volume overload and high cardiac output stare in patients on chronic hemodialysis cause an eccentric hypertrophy which is correlated with an ominous cardiovascular prognosis. Furthermore, factors associated with the uremic state as anemia and hyperparathyreoidism are considered as important in the pathogenesis of LVH as well, It has been demonstrated that a prolonged antihypertensive therapy including P-blockers, calcium antagonists, and ACE inhibitors with strict blood pressure control decreases left ventricular mass and renormalizes left ventricular wall thickness after 6 - 24-month-duration of therapy, ACE inhibitors seem to be more potent than beta blockers and diuretics in reduction of left ventricular wall thickness and mass index. Activation of the renin angiotensin system has been shown to act as a trophic stimulus on the myocardial cell; as a consequence, blockade of angiotensin ii with ACE inhibitors may contribute, independently of blood pressure reduction, to the reversal of myocardial hypertrophy. In patients after renal transplantation calcium antagonists are suggested to have a potential cardioprotective effect by preventing LVH, independently of blood pressure control. However, these study results are limited by the small number of subjects participating in clinical trials. Renal transplantation leads to a significant regression of left ventricular hypertrophy and improves cardiovascular survival of patients with a renal transplant over that of patients on long-term dialysis. Furthermore, correction of the anemia by recombinant human erythropoietin has been proved to be effective in reversing the LVH in patients with end-stage renal disease. Beside this, a range of nonpharmacological measures like weight reduction and salt restriction has been shown to be associated with reduction of left ventricular mass due to better control of arterial hypertension.