[Left ventricular hypertrophy in hypertensive patients. Epidemiology and prognosis]

The aim of this review is to analyze the epidemiology and prognosis of left ventricular hypertrophy (LVH) in hypertensive patients through literature data and to identify clinical factors contributing to its development. After an exhaustive review of literature through Medline database, eighteen studies (including 8 European ones) have been selected. The prevalence of LVH diagnosed by EKG (7 studies) is steadily over 15%. It can reach 50% in some subgroups of the Framingham study. Among 11 studies using echocardiography as diagnostic tool, the prevalence varies from 14 to 44% (Bordeaux cohort). In the Framingham study, 32% of men and 45% of women over 60 years presented an echography-defined LVH. The variations observed in different studies may be explained by differences on the modes of enrollment and diagnosis. The clinical factors associated with the occurrence of LVH are age, which can be confounded with the duration of presence of hypertension, the severity and lack of therapeutic management of hypertension. Thirteen studies permitted to quantify the cardiovascular risk related to hypertension. In hypertensive patients, the presence of EKG-LVH or the one observed by echocardiography would correspond to a two-fold increase of cardiovascular mortality and morbidity. Moreover, a cardiovascular risk gradient is observed according to the LVH geometry (concentric remodeling, followed by eccentric LVH and concentric LVH). Three studies including the Framingham study demonstrated that LVH is a major risk factor of stroke. This exhaustive literature review stresses on the high prevalence and the severity of LVH during hypertension. Its diagnosis allows to identify high cardiovascular risk patients suffering from hypertension. It emphasizes on the importance of an early and careful therapeutic management of hypertension.