• Most people who are diagnosed with hypertension also undergo an electrocardiogram. Following your first EKG, ask your doctor if your left ventricle is overly thickened. • If so, talk to your doctor about whether you should have repeat EKGs to see if the wall thickness is reduced by taking medications to control your blood pressure. • If your blood pressure comes down but your left ventricle remains excessively thick, talk to your doctor about switching anti-hypertensive medications. • Lose weight to help reduce left ventricle enlargement. Source: Michael Lauer, M.D.

Big-hearted, at-risk In societies that value bulked-up muscle, big-hearted generosity and thick-skinned courage, it may sound like heresy to suggest that averaged-sized, thinner-walled hearts are likely to keep beating longer. But to cardiologists, particularly in the wake of the new research, a greatly enlarged heart signals trouble. In particular, an extreme increase in the muscle mass of the lower left chamber (ventricle) often means the patient has chronic heart disease. The muscled wall of the left ventricle is responsible for pumping blood up and out, through the aorta, to the body and brain. Doctors call the abnormal thickening left ventricular hypertrophy (ven-TRICK-u-lar hi-PURR-tre-fee). It’s true that a slightly enlarged heart may be a sign of strength, allowing the cardiac muscle to respond to extra demands like playing professional football, running marathons or pedaling in the Tour de France. The typical patient with an enlarged heart, though, is more likely to be inactive, obese, and vulnerable to a steady, silent assault from hypertension. The extra strain on the left ventricle causes it to work harder. In response to even mild increases in blood pressure, the chamber thickens. As the heart loses flexibility, it doesn’t fill as efficiently with blood. So the flow can back up into the lungs, and make breathing more difficult. Some patients develop shortness of breath. Many others notice no symptoms. Partly because of its silence, “left ventricular hypertrophy is an under-appreciated risk factor,” says Michael Lauer, M.D., a professor of medicine at The Cleveland Clinic. But “unlike some other risk factors, it is clearly modifiable.” While doctors know it’s important to treat hypertension and obesity, they haven’t agreed on the need to reduce left ventricle wall thickness in these patients. The question is: In addition to diagnosing and treating blood pressure, should doctors be tracking the size of the left ventricular mass? Based on emerging scientific evidence, the answer appears to be yes. The two new studies indicate that treating excessive wall thickness is a good idea in itself, over and above taming hypertension. How to reduce the risks Participants in one study received one of two blood pressure medications. Both drugs, losartan and atenolol, were about equally effective against hypertension. But losartan did a better job of reducing wall thickness. Findings from this and a second study were consistent in showing that the greater the reduction in heart muscle mass, the greater the protection from heart attacks, strokes and cardiac death. (November 17 2004 Journal of the American Medical Association. Dr. Lauer was co-author of an editorial in the same issue.) The studies show that it may be important to enlist a two-for-one medication that lowers blood pressure and reduces left ventricular mass. “These data are very compelling,” Dr. Lauer says. “We need to look at much more than just blood pressure. A strategy aimed at left ventricular mass reduction may be beneficial.” Researchers will have to probe deeper to determine which medications work best at countering heart enlargement. But in the future, he says, “the blood pressure drug you use may depend on left ventricular mass. We’ll need to follow two measurements. That’s the next major step.”