Detection of hypertensive left ventricular hypertrophy.

The risk of adverse cardiovascular events is higher in persons with electrocardiographic evidence of left ventricular hypertrophy, and the decision to treat patients with antihypertensive drugs is often determined by the presence of hypertrophy. In this study a number of electrocardiographic criteria for detection of left ventricular hypertrophy were applied to a population of 85 hypertensive subjects in an ongoing outpatient hypertension evaluation and treatment program. Included were one set of criteria in common use and three sets of criteria employed in prospective clinical trials. The results were compared with those obtained by M-mode echocardiography and left ventricular wall thickness of 12 mm or more, which was taken as an indicator of hypertrophy. By this criterion, 34 patients (40%) had left ventricular hypertrophy. The most sensitive of the electrocardiographic criteria allowed detection of only 13 (38%) of those hypertensive subjects with anatomical-echocardiographic left ventricular hypertrophy. Although the echocardiogram is more time-consuming to obtain and more expensive than the electrocardiogram, its superior sensitivity suggests that the echocardiogram should be used for evaluating patients with high blood pressure, especially those without electrocardiographic evidence of left ventricular hypertrophy, to detect anatomical left ventricular hypertrophy.