Clinical implications and treatment of left ventricular hypertrophy in hypertension
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
- Pamela S Douglas, MD
Pamela S Douglas, MD
- Ursula Geller Professor of Research in Cardiovascular Diseases
- Duke University Medical Center
Left ventricular hypertrophy (LVH) is a common finding in patients with hypertension and can be diagnosed either by ECG or by echocardiography . The latter is the procedure of choice since the sensitivity of the different ECG criteria may be as low as 7 to 35 percent with mild LVH and only 10 to 50 percent with moderate to severe disease . Nevertheless, if echocardiography is unavailable or too expensive, appropriate ECG criteria can be used to detect increased LV mass .
The clinical implications and therapy of LVH in hypertension will be reviewed here. The definition and pathogenesis of this complication in hypertensive patients are discussed separately. (See "Definition and pathogenesis of left ventricular hypertrophy in hypertension".)
LVH AND INCREASED CARDIOVASCULAR RISK
The presence of LVH (on ECG or echocardiography) is important clinically because it is associated with increases in the incidence of heart failure, ventricular arrhythmias, death following myocardial infarction, decreased LV ejection fraction, sudden cardiac death, aortic root dilation, and a cerebrovascular event.
LVH diagnosed by echocardiography, which is much more sensitive than the ECG, also carries an increased risk for cardiac events (angina and myocardial infarction, heart failure, and serious ventricular arrhythmia), stroke, and cardiovascular deaths [4-10]. Furthermore, the increase in cardiovascular risk is directly related to the degree of increase in left ventricular mass (figure 1 and figure 2) [4,6-8], an effect that is independent of blood pressure .
The range of findings is illustrated by the following observations:
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