Actual aspects of pathogenesis and treatment of asymmetric left ventricular hypertrophy in essential hypertension

Background: asymmetric left ventricular hypertrophy (ALVH) is the rarest type of hypertensive left ventricular (LV) remodeling, which is prevalent in approximately 1% of people with essential hypertension (EH). Aim: to estimate 24-h blood pressure (BP) parameters, ultrasound left ventricle features, sympathetic and rennin-angiotensin-aldosterone system (RAAS) activity, insulin secretion level, and to assess the efficacy of RAAS pharmacologic blockade in EH patients with ALVH. Material and methods: we examined 101 EH subjects with 1-3 degree of BP increase (ESC/ESH, 2007) and I-II stages of hypertension. 37 of them had ALVH, 32 ones had symmetric LVH (SLVH), 32 people had normal LV geometry. Results: Patients with ALVH in comparison with SLVH people demonstrated a significantly higher LV mass index (LVMI, p < 0,001), LVH concentricity degree (p < 0,001), 24-h epinephrine excretion levels (p < 0,05), aldosterone and insulin secretion levels (p < 0,001). 24-week therapy based on angiotensin-converting enzyme inhibitor (ACEi) Quinapril resulted in significant reduction of 24-h systolic and diastolic BP (p < 0,05), LVMI (p < 0,001), 24-h epinephrine (p < 0,01) and norepinephrine (p < 0,001) excretion levels, aldosterone secretion level (p < 0,001). Conclusions: asymmetric (i.e. non classic) type of LVH is a result of interaction of traditional proliferateive haemodynamic and neurohumoral patterns and also it can be a target for RAAS-blockade.