ACE INHIBITOR-INDUCED ANATOMICAL REMODELING AND MASS REGRESSION OF THE LEFT VENTRICLE IN CKD-ASSOCIATED HYPERTENSION: A COMPREHENSIVE NARRATIVE REVIEW
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Abstract
Left ventricular hypertrophy (LVH) and adverse cardiac remodeling are highly prevalent cardiovascular complications in patients with chronic kidney disease (CKD), driven primarily by sustained hypertension, arterial stiffness, activation of the renin–angiotensin–aldosterone system (RAAS), and chronic volume overload. Among available antihypertensive strategies, angiotensin-converting enzyme (ACE) inhibitors have demonstrated unique benefits extending beyond blood pressure control, including regression of LV mass (LVM), attenuation of myocardial fibrosis, reversal of geometric remodeling, and improvement in diastolic function. This narrative review synthesizes physiological mechanisms, clinical evidence, and therapeutic considerations surrounding ACE inhibitor–mediated left ventricular structural improvement specifically in CKD-associated hypertension. Evidence from randomized controlled trials, longitudinal cohort studies, and mechanistic investigations consistently supports ACE inhibitors as a foundational therapy for LV remodeling in CKD, independent of their hemodynamic effects. Remaining research gaps include the influence of CKD stage, sodium retention status, biomarker-guided therapy, and long-term outcomes. Understanding ACE inhibitor–induced cardiac remodeling in CKD is essential for optimizing cardiovascular risk reduction in this high-risk population.
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Dr. Syed Hasnain Mujtaba
Ziauddin Medical University, MBBS, MRCP (UK), FRCP (London), FRCP (Edinburgh)
Dr. Fahad Nasim
FCPS (Nephrology), Sindh Medical College, Assistant Professor, Liaquat National Hospital & Medical College, Karachi
Dr. Amatul Sughra
MBBS, M.Phil (Anatomy), Hamdard University of Medicine & Dentistry
Dr. Amber Shams
Professional Diploma in Gynaecology & Obstetrics, RCPI, Ireland MBBS, Liaquat University of Medical and Health, FCPS-I (Gynaecology & Obstetrics) Sciences (LUMHS), Jamshoro, Pakistan
