Investigative Concerns in Demonstrating Reduced Risk from Reversing Left Ventricular Hypertrophy

Background: To demonstrate reduced risk from reversing left ventricular hypertrophy (LVH) in hypertension, one must show that it is independent of blood pressure reduction.Methods and Results: A feasibility study was conducted with 15 patients. The study employed 48-hour Holter recording, exercise treadmill (for ST-segment changes) and, as nec essary, thallium scintigraphy and coronary angiography. All patients were treated for 3 months with quinapril (10 mg) and demonstrated decreased mean arterial pressure (125 ± 3.1 vs 103 ± 1.9 mmHg; P < .01) and left ventricular mass index (125 ± 6.4 vs 104 ± 4.9; P < .02) with preserved left ventricular function. There were no significant changes in these patients with moderate LVH in the incidence of arrhythmias; however, 4 of the 15 patients developed ST-segment changes prior to LVH reversal, and these changes did not recur in 3 patients following reversal of LVH or when pressure was allowed to rise.Conclusions: Ischemic changes, rather than development of arrhyth...