Obesity and left ventricular hypertrophy: the hypertension connection

The detection of left ventricular hypertrophy (LVH) is recommended for risk prediction, and changes in LV geometry may provide further prognostic information. Obesity is a major determinant of LVH, but the approach to LVH detection in obese hypertensives remains a challenge. In the present review, we discuss evidence leading to the recent acceptance of the use of LV mass indexed to height(2.7) or height(1.7) rather than body surface area, for LVH detection and its regression in obesity. We also review recent findings which indicate that obesity-induced LVH may be associated with concentric LV remodeling, and hence, that the presence of concentric LVH in obesity should not be assumed to indicate a cause of LVH other than obesity. We also discuss recent evidence for obesity and blood pressure producing additive and interactive effects on LV mass, and hence, that weight loss and blood pressure reduction are required to achieve appropriate regression.