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Definition and pathogenesis of left ventricular hypertrophy in hypertension

Authors
Pamela S Douglas, MD
Gerald S Bloomfield, MD, MPH
Section Editor
George L Bakris, MD
Deputy Editors
John P Forman, MD, MSc
Brian C Downey, MD, FACC

INTRODUCTION

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 [3]. 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 [4]. 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".)

DEFINITION

Heart disease resulting from hypertension can be divided into four degrees of severity; LVH defines degree II [7]:

Degree I – Isolated LV diastolic dysfunction with no LVH

Degree II – LV diastolic dysfunction with concentric LVH

           
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Literature review current through: Oct 2017. | This topic last updated: Nov 15, 2017.
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