Role of ACE inhibitors in hypertension with left ventricular hypertrophy.

Left ventricular hypertrophy in hypertension is an independent predictor for sudden death, ventricular arrhythmias, myocardial ischaemia, coronary heart disease, and heart failure. `-9 These relations have proved true whether the hypertrophy is detected by electrocardiography or by the much more sensitive technique of echocardiography. It seems logical that regression of left ventricular hypertrophy would be beneficial, but, as yet, few clinical data support this contention beyond a limited experience from the Framingham study. Antihypertensive treatments might differ in their ability to promote regression of left ventricular hypertrophy independently of their blood pressure lowering effect. There is a powerful theoretical basis suggesting that inhibition of angiotensin converting enzyme (ACE), with consequent reduction in plasma and tissue concentrations of angiotensin II, may be superior in promoting regression of left ventricular hypertrophy. Studies in animal models of hypertension and meta-analyses of trials of drug treatment in human hypertension are not entirely concordant, but overall they support a major role for ACE inhibitors in reducing left ventricular hypertrophy.