How would you manage a 60-year-old patient with elevated BP, congestive heart failure (CHF), normal heart size, and left ventricular hypertrophy (LVH) and diastolic dysfunction confirmed on echocardiography?
—Mohan L. Singhal, MD, Woodmere, N.Y.
This pattern fits a common clinical scenario: CHF due to hypertension-induced LVH with LV diastolic dysfunction but normal heart size and normal systolic function. The LVH is potentially reversible with a variety of agents, including the vasodilators quinapril (Accupril) and amlodipine (Norvasc). Either of these agents (along with duretics) is also good therapy for LV diastolic dysfunction.
—Peter F. Cohn, MD (116-8)