Definition and pathogenesis of left ventricular hypertrophy in hypertension
- Pamela S Douglas, MD
Pamela S Douglas, MD
- Ursula Geller Professor of Research in Cardiovascular Diseases
- Duke University Medical Center
- Gerald S Bloomfield, MD, MPH
Gerald S Bloomfield, MD, MPH
- Assistant Professor of Medicine & Global Health
- Duke University
- Section Editor
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
- Deputy Editors
- John P Forman, MD, MSc
John P Forman, MD, MSc
- Senior Deputy Editor — UpToDate
- Deputy Editor — Nephrology
- Assistant Professor of Medicine
- Harvard Medical School
- Brian C Downey, MD, FACC
Brian C Downey, MD, FACC
- Deputy Editor — Cardiology
- Assistant Professor of Medicine
- Tufts University School of Medicine
Left ventricular hypertrophy (LVH) is a common finding in patients with fixed or borderline hypertension and can be diagnosed either by electrocardiography (ECG) or by echocardiography [1,2]. Echocardiography is the diagnostic 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 . In a report from the Treatment of Mild Hypertension Study, for example, almost none of 844 patients had ECG criteria for LVH, while echocardiographic LVH (indexed by body surface area, see below) was present in 13 percent of men and 20 percent of women . Nevertheless, if echocardiography is unavailable or too expensive, appropriate ECG criteria can be used to detect increased LV mass [5,6]. (See "Electrocardiographic diagnosis of left ventricular hypertrophy".)
The definition and pathogenesis of LVH in hypertension will be reviewed here. The clinical implications of and effects of therapy on this complication and the indications for echocardiography in hypertensive patients are discussed separately. (See "Clinical implications and treatment of left ventricular hypertrophy in hypertension".)
Heart disease resulting from hypertension can be divided into four degrees of severity; LVH defines degree II :
●Degree I – Isolated LV diastolic dysfunction with no LVH
●Degree II – LV diastolic dysfunction with concentric LVHTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- PATHOGENESIS OF LVH IN HYPERTENSION
- Role of renin-angiotensin system
- Role of endothelin
- Role of heterotrimeric G proteins
- Role of cardiac sodium-potassium pumps
- Genetic tendency to LVH
- Micro RNAs
- Impact of coronary artery disease or valvular disease
- Other factors