Abstract
Hypertensive damage to the target organ “heart” comprises the sum and interactions of the cardiac organ manifestations of arterial hypertension such as myocardial hypertrophy and disease of large and small coronary arteries. Because the prognosis of arterial hypertension is determined to a considerable extent by these cardiac complications, the aim of treatment of hypertensive heart disease is reversal of the myocardial hypertrophy in order to prevent later progression to hypertensive heart failure. A further goal of therapy is reversal of the hypertensive small coronary disease in order to improve the coronary reserve. Once the stage of hypertensive heart failure is reached, the principles of medical management of heart failure with digitalis, diuretics and angiotensin-converting enzyme inhibitors apply. Whereas the evidence that regression of hypertrophy can be induced by suitable antihypertensive drugs (calcium channel blockers of the dihydropyridine type, angiotensin-converting enzyme inhibitors and sympathicolytic substances) is practically conclusive, clinical evidence of reversal of the hypertensive disease of small coronary arteries has yet to be provided. Moreover, to what extent the prognosis of hypertensive heart disease can be improved by reversal of hypertrophy is still unknown.
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