Significance of Beta-Blocker in Patients with Hypertensive Left Ventricular Hypertrophy and Myocardial Ischemia

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 of 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 in the absence of 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 were not able to 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.

Hypertensive Heart Disease: Mechanisms, Diagnosis and Treatment

“…Beta-blockers should be preferred for heart rate control in patients with myocardial infarction [ 245 ]. There is a lack of recommendations for the use of beta-blockers in hypertensive LVH without coronary heart disease, possibly due to the limited effect in reversing LVH [ 246 , 247 ]. However, beta-blockers are superior to other antihypertensive medications in alleviating myocardial ischemia and preventing tachyarrhythmia in hypertensive LVH [ 246 , 247 ].…”

“…There is a lack of recommendations for the use of beta-blockers in hypertensive LVH without coronary heart disease, possibly due to the limited effect in reversing LVH [ 246 , 247 ]. However, beta-blockers are superior to other antihypertensive medications in alleviating myocardial ischemia and preventing tachyarrhythmia in hypertensive LVH [ 246 , 247 ]. Thus, beta-blockers possibly offer irreplaceable advantages in the treatment of HHD.…”