IV. PREVENTION AND MANAGEMENT
Hypertension is the main cause of left ventricular hypertrophy and aggressive treatment of hypertension
can prevent it. Some antihypertensive agents are, however, not effective in preventing hypertrophy. With some agents the blood pressure may be lowered but hypertrophy may not be arrested and may not show regression.
A. Alpha-Blockers
Alpha-1 receptor adrenergic blockers include prazosin, terazosin, and doxazosin. Several clinical studies have shown that these agents do not prevent hypertrophy, and in some instances they have shown an insignificant increase in left ventricular mass. The reason for their lack of effectiveness is probably related to the fact they stimulate the heart and increase ejection velocity as well as heart rate. This calls for more effort because the heart has to work harder. In addition, these agents increase norepinephrine levels that stimulate the sympathetic nervous system. They also cause sodium and water retention as well as increased incidence of heart failure. The ALLHAT study indicated that these agents increase morbidity and mortality due to heart failure in hypertensive patients and they are no longer recommended. These agents were widely used for the management of hypertension from 1970 to 2001 because they do cause a lowering of blood pressure and do not have deleterious effects on blood lipid levels. They are still prescribed by specialists who give them to diabetic patients because they do not raise blood lipid levels.