Title:Significance of Beta-Blocker in Patients with Hypertensive Left Ventricular
Hypertrophy and Myocardial Ischemia
Volume: 21
Issue: 2
Author(s): Goran Koracevic, Slađana Mićić, Milovan Stojanovic*, Nenad Bozinovic, Dragan Simic, Dragan Lović, Nebojsa Krstic and Ružica Janković Tomašević
Affiliation:
- Department of Cardiovascular
Diseases, University of Niš, Niš, Serbia
Keywords:
Coronary artery disease, myocardial ischemia, arterial hypertension, beta-blockers, sudden cardiac death, ventricular tachycardia, ventricular fibrillation, left ventricular hypertrophy.
Abstract:
Background: Arterial Hypertension (HTN) is a key risk factor for left ventricular hypertrophy
(LVH) and a cause of ischemic heart disease (IHD). The association between myocardial ischemia
and HTN LVH is strong because myocardial ischemia can occur in HTN LVH even in the absence of
significant stenoses of epicardial coronary arteries.
Objective: To analyze pathophysiological characteristics/co-morbidities precipitating myocardial ischemia
in patients with HTN LVH and provide a rationale for recommending beta-blockers (BBs) to
prevent/treat ischemia in LVH.
Methods: We searched PubMed, SCOPUS, PubMed, Elsevier, Springer Verlag, and Google Scholar for
review articles and guidelines on hypertension from 01/01/2000 until 01/05/2022. The search was limited
to publications written in English.
Results: HTN LVH worsens ischemia in coronary artery disease (CAD) patients. Even without obstructive
CAD, several pathophysiological mechanisms in HTN LVH can lead to myocardial ischemia. In the
same guidelines that recommend BBs for patients with HTN and CAD, we could not find a single recommendation
for BBs in patients with HTN LVH but without proven CAD. There are several reasons
for the proposal of using some BBs to control ischemia in patients with HTN and LVH (even in the
absence of obstructive CAD).
Conclusion: Some BBs ought to be considered to prevent/treat ischemia in patients with HTN LVH
(even in the absence of obstructive CAD). Furthermore, LVH and ischemic events are important causes
of ventricular tachycardia, ventricular fibrillation, and sudden cardiac death; these events are another
reason for recommending certain BBs for HTN LVH.
