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Dr. Andrew Rynne
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Dr. Andrew Rynne

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What causes left ventricular hypertrophy?

Answered by
Dr.
Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 7096 Questions

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Posted on Mon, 29 Aug 2016 in Hypertension and Heart Disease
Question: 1. What type of medication would be favored or preferred to delay the progression of CHF (and potentially reverse to any degree Left Ventricular Hypertrophy) in a 93 y/o with "mild LVH" as seen on Echo. Beta blocker, ACE Inhibitor, or an Angiotensin II Receptor Antagonist? I understand that often, multiple types are prescribed, but I don't think she will take more than one. Looking for biggest bang for the buck here.

2. Given the response, what is the absolute minimum dosage per day that it would take to achieve some degree of benefit between Losartin, Toprol XL, Lisinopril?
doctor
Answered by Dr. Ilir Sharka 22 minutes later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

Regarding your concern, I would explain that the main cause of LVH usually is uncontrolled high blood pressure.

A better control of her blood pressure would stop further progression of LVH and eventually CHF.

From the other hand, as she has gone through a mild MI I would recommend starting an ACEI and a betablocker as both these drugs are really beneficial in this situation and have been proven to increase the lifespan.

Anyway, betablockers should be used with caution.

I would recommend starting lisinopril starting at a dose of 5mg daily.

Regarding Toprol XL, I would recommend starting at a dose of 25mg daily.

I would not recommend taking losartan as it belongs to ARB class and this class of drugs is not the best in this clinical situation (considering past MI).

Another advise I would give is diet modifications:

a- reduce salt and caffeine intake in order to have a better control of her blood pressure
b- take plenty of fibers to avoid constipation, as it can trigger possible acute coronary events.

Hope you will find this answer helpful!

Feel free to ask any other questions whenever you need!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 48 minutes later
Thank you.

Interesting on the High Blood Pressure being a causative factor. Prior to being placed on meds, her BP was very inconsistent ... most times being normal (or close) but a few times the systolic was between 130 - 150.

She is very very leary about medications and is reluctant to take anything. She tried lisonopril 5mg and claims it caused her to have running nose and stomach upset (I don't believe these are prominent side effects of that drug). She's currently back on Toprol XL but won't take the full 25mg claiming it puts her to sleep so she's taking 12.5 mg per day. She is cooperative for the most part on diet.

1. What type of "caution" needs to be taken with beta-blockers? I'm aware of the risk of orthostatic hypotension and she seems to not be experiencing much of that.

2. I understand that a beta blocker and a ACE I would be best, but if she will only take one medication of the two, is there one that would be preferable?

Thanks very much for your help!
2.
doctor
Answered by Dr. Ilir Sharka 11 minutes later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello again!


The above mentioned doses (25mg of Toprol and 5mg of lisinopril) are the minimal therapeutic doses for these drugs.

This means that lower doses have no effect on her body, but only adverse effects.

So, I would not recommend taking lower doses.

Regarding betablockers the caution consists in using the smallest doses possible in order to not interfere with her heart contractility and heart rate. Higher doses of betablockers can cause further decrease in heart contractility and heart rate.

Regarding your third question, I would prefer taking both Toprol and lisinopril. If she really needs to take only one, I would prefer lisinopril.

If she has gastric problems, ranitidine or a PPI (omeprazole, lansoprazole) would be helpful to minimize these troubles.

Hope you will find this answer helpful!

Best wishes,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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