Hello Mr XXXXXXX XXXXXXX

Thank you for your query.

You have indicated that you have left ventricular hypertrophy. As you said, this is indeed related to your Hypertension. The increase in the left ventricular muscle mass and thickness is the response of the heart to its increased workload of having to pump blood against a higher blood pressure. This is somewhat similar to the increase in your biceps when you lift weights.

When you keep your BP under control 24 x 7, there will be a gradual reduction in the degree of left ventricular hypertrophy.

Propranolol is a beta blocker and a good drug for your extra-systoles as well as your BP. However, this is relatively short-acting and can have more side effects. You could discuss with your treating physician about the possibility of switching over to a highly specific beta blocker like Metoprolol succinate extended release preparation. Alternately, you could also consider an ACE (Angiotensin Converting Enzyme) inhibitor like Ramipril or Lisinopril to achieve good BP control, prevent kidney dysfunction and reduce the LVH.

I understand that your CT chest has been done with the primary aim of looking at the 2 nodules in your lungs. For the coronaries, you need a multi-slice ECG gated CT coronary angiogram to be able to fully delineate the coronary anatomy and establish the presence/absence of any blockages.

In view of your risk factors like diabetes and hypertension, you could also consider a stress test like treadmill exercise test, dobutamine stress echo or a nuclear perfusion imaging test like a stress thallium or stress technitium sestamibi test. These are non-invasive and will indicate the need for any further invasive coronary angiogram/other procedures.

I hope this answers your query. Feel free to contact me for any further clarifications.
Please accept my answer in case you have no further queries.

With regards,
Dr RS Varma

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Dear Mr. XXXXXXX XXXXXXX

Thank you for the follow-up.

The LVH (Left Ventricular Hypertrophy) can be related to the long-standing hypertension and may sometimes be related to increasing age also. Since the BP (Blood Pressure) is under good control now, there will be some regression of the LVH. If there are fibrotic changes, the regression of LVH may not be complete or may be slow.

Propranolol, as indicated earlier, is a non-selective beta blocker and has anti-hypertensive effects. It will bring down the BP and slow the heart rate also. Due to its non-selective nature and short duration of action, it is not the ideal drug for BP control. It is good for your panic episodes, however.

You could either switch over to a long-acting, beta-1 specific agent like metoprolol succinate or you could consider an ACE (Anti-Cholinesterase) inhibitor which has been shown in trials to cause regression of LVH. Do not stop propranolol suddenly. It has to be slowly tapered and stopped over a period of weeks.

Since you are asymptomatic and exercising regularly, your general fitness levels are likely to be good. The lack of increase in heart rate during exercise is related to the propranolol. This indicates a good and desirable effect of the drug.

BP levels do show some long term fluctuations. Though you needed 3 drugs initially for BP control, now the same effect is achieved with one drug. This is partly due to the long term effects of good beta receptor blockade by propranolol. It is also due in a major part to the positive effects of your lifestyle with adequate diet and appropriate exercise regimens. Changes in stress levels and the adaptations of the body can also contribute.

However, you need to keep on monitoring the BP. It might rise again after a period of time. These variations over a period of time are well known.

Keeping your BP at optimal values of <130/80 mmHg throughout the day and night over long periods of time is the best way to reduce the LVH. Since you may have only a mild LVH, and since you are asymptomatic, I don’t think you need to be excessively worried about it.

If you have undergone a stress test and found to be negative for inducible ischemia, you don't need to worry about bypass surgery. This surgery is for those with multiple severe and critical blockages in the coronary arteries. Nowadays, angioplasty with stenting is an effective alternative to surgery in many patients. Advances in the medicines that are available for medical management of diabetes, hypertension, high cholesterol and coronary artery disease also have resulted in good prevention of heart disease and reduced need for bypass surgery.

I hope this serves to clarify all the issues that you have raised. I wish you all the best for a happy and healthy life ahead.

With regards,
Dr RS Varma

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