ReviewsHypertensive left ventricular hypertrophy risk: beyond adaptive cardiomyocytic hypertrophyFrohlich, Edward Da; González, Arantxab; Díez, Javierb,c Author Information aOchsner Clinic Foundation, New Orleans, Louisiana, USA bDivision of Cardiovascular Sciences, Centre of Applied Medical Research, Spain cDepartment of Cardiology and Cardiovascular Surgery, University Clinic, University of Navarra, Pamplona, Spain Received 30 July, 2010 Revised 14 September, 2010 Accepted 21 September, 2010 Correspondence to Javier Díez, MD, PhD, Centro de Investigación Médica Aplicada Av. Pío XII, 55, 31008 Pamplona, Spain E-mail: [email protected] Journal of Hypertension: January 2011 - Volume 29 - Issue 1 - p 17-26 doi: 10.1097/HJH.0b013e328340d787 Buy Metrics Abstract The heart is a remarkably adaptive organ, capable of increasing its minute output and overcoming short-term or prolonged pressure overload. The structural response, in addition to the foregoing functional demands, is that of myocardial hypertrophy. Then, why should an adaptive response increase cardiovascular risk in hypertensive patients with left ventricular hypertrophy (LVH)? Evidence shows that the functional performance of hypertrophied cardiomyocytes is impaired, and that additional alterations develop in cardiomyocytes themselves, the extracellular matrix and the intramyocardial vasculature, leading to myocardial remodelling and providing the basis for the adverse prognosis associated with pathological LVH in hypertensive patients (i.e., hypertensive heart disease, HHD). As molecular information accumulates, the pathophysiological understanding and the clinical approach to HHD are changing. The time has come to develop novel diagnostic and therapeutic strategies aimed at improving the prognosis of HHD on the basis of reversing or even preventing the aforementioned changes in the ventricular myocardium. © 2011 Lippincott Williams & Wilkins, Inc.