Dramatic Reverse Left Ventricular Remodeling by Carvedilol in Hypertensive Cardiomyopathy: A Case Report

Abstract

A 51-year-old man had a 17-year history of untreated hypertension. He was first referred to our hospital because of orthopnea in July 2003. On admission, blood pressure level was 202/110 mmHg. Chest radiography and echocardiography showed cardiomegaly with lung congestion and diffuse severe hypokinesis (LVEF; 23%) with LVDd of 76 mm, respectively. A month after the treatment of congestive heart failure with conventional medication, patient's symptoms were decreased concomitant with improved cardiomegaly with lung congestion and the decreased in plasma BNP level (CTR; 61 to 51%, BNP level; 1,540 to 127 pg/mL, respectively). However, echocardiography showed still diffuse severe hypokinesis. To exclude ischemic cardiomyopathy, we performed coronary angiography and left ventriculography that revealed normal coronary arteries and diffuse hypokinesis (LVEF; 35%). Therefore, we finally made a diagnosis hypertensive cardiomyopathy. One year after the treatment including carvedilol, angiotensin II receptor blocker and diuretics, clinical status was gradually improved. In addition, echocardiography revealed that LVDd reduced 76 mm to 53 mm and LVEF increased 23% to 63%. So, we could stop prescription of diuretics. After a 6-year follow-up period, he remains asymptomatic and echocardiography continue to show normal LVDd and LVEF with normal BNP level. Here, we reported a case of hypertensive cardiomyopathy who had a dramatic reverse left ventricular remodeling by the treatment of carvedilol.