7 THE USE OF ANTI HYPERTENSIVE THERAPY BASED ON GEOMETRY PATTERN OF LEFT VENTRICULAR HYPERTROPHY IN PATIENTS WITH HYPERTENSIVE HEART DISEASE IN DR. M. DJAMIL GENERAL HOSPITAL PADANG

Abstract

Background: Hypertension is mayor risk factor for coronary heart disease (CHD), stroke and also mostly found in heart failure. Left ventricular hypertrophy (LVH), defined by an increase in left ventricular mass (LVM), is a common cardiac finding generally caused by an increase in pressure or volume load. Hypertension induces a compensatory thickening of the ventricular wall as an attempt to normalize wall stress, which results in LV concentric hypertrophy, which in turn decreases LV compliance and LV diastolic filling. The aim of this study to describe the pattern of anti-hypertensive treatment based on LVH severity determined by trans thoracic echocardiography (TTE). Method: This was a descriptive retrospective study in patient with LVH who underwent TTE examination from January until December 2018. Clinical and echocardiographic characteristic data were taken from echocardiography laboratories registry and medical records in our hospital. Subject were excluded if any of concomitant disease which will affect the LV appeared. Result: We found 831 patients with LVH, there were no significant sex differences in these patients and the average age was 59 years old. Patients were divided into three groups based on the severity of left ventricular hypertrophy, namely concentric remodeling (CR), concentric hypertrophy (EH) and eccentric hypertrophy (EH). The average ejection fraction of the three groups was 63%. Concentric remodeling is the most commonly found LVH geometry pattern followed by CH and EH with total 421 (50.6%), 336 (40.4%) and 74 (8.9%) patients, respectively. Patients with CH and EH have relatively uncontrolled blood pressure compared with CR patients. Therapy in CR is dominated by mono therapy (73%), whereas in CH combination therapy with two types of drugs is more widely used (51%) although there is still 26% mono therapy, and in EH triple therapy or more is given up to 44% compared with mono and dual therapy which only 27% and 26%. The order of drug prescribed as monotherapy was angiotensin-converting enzyme inhibitors (ACEI) > angiotensin receptor blockers (ARB) > calcium channel blockers (CCB) > Beta blockers (BB) > diuretic. The order for dua theraphy was ACEI+CCB > ARB+CCB > ACEI+BB > ARB+BB > ACEI+Diuretic, and for triple therapy was ACEI+CCB+Diuretic > ACEI+CCB+BB > ARB+CCB+BB. Conclusion: The use of anti-hypertensive combination therapy was increased with the severity of left ventricular hypertrophy. It was found that patients with a higher severity of LVH relatively had poor controlled blood pressure even though combination therapy was given. It is expected that in the future combination therapy regimens must be adopted as per the guidelines for achievement of blood pressure goals followed by compliance from patients themselves.