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Echocardiography, hypertension, and left ventricular mass
1Division of Cardiology, New York Hospital-Cornell Medical Center, NY 10021.
Insights
Echocardiography detects left ventricular hypertrophy (LVH) in over 20% of hypertension patients. This finding, linked to home blood pressure readings, helps identify high-risk individuals for early drug treatment.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Imaging
Background:
- Systemic hypertension affects a significant portion of the population.
- Left ventricular hypertrophy (LVH) is a common cardiac adaptation to hypertension.
- Traditional electrocardiography has limitations in detecting LVH.
Purpose of the Study:
- To evaluate the prevalence of LVH in patients with systemic hypertension using echocardiography.
- To explore the relationship between LVH, blood pressure measurements, and cardiac function.
- To assess the prognostic value of echocardiographically detected LVH in hypertensive patients.
Main Methods:
- Utilized echocardiography for sensitive detection of left ventricular hypertrophy (LVH).
- Compared LVH prevalence based on population characteristics (sex, race, age).
- Correlated LVH with blood pressure measured in natural settings versus clinical settings.
Main Results:
- Echocardiography revealed LVH in 20% or more of hypertensive patients.
- LVH prevalence varied with population demographics.
- Blood pressure in natural settings showed a stronger correlation with LVH than physician-measured pressure.
- Some hypertensive patients showed high cardiac output without LVH, while others had concentric LVH with high ejection fractions.
Conclusions:
- Echocardiography is a sensitive tool for diagnosing LVH in hypertensive patients.
- Echocardiographically detected LVH identifies patients at significant risk, even with mild hypertension.
- This diagnostic approach can guide the selection of hypertensive patients for pharmacologic therapy.
Abstract:
The greater sensitivity of echocardiography than electrocardiography has revealed left ventricular hypertrophy (LVH) to be present in 20% or more of patients with systemic hypertension, with the exact prevalence dependent both on how a population is selected and on the sex, race, and possibly age composition of its members. LVH is more closely related to blood pressure recorded in the patient's natural setting during normal activity or exercise-whether measured by portable recorder or home manometer-than to blood pressure measured by the physician. A subgroup of patients with mild essential hypertension exhibit high cardiac output and evidence of supernormal myocardial contractility in the absence of LVH, whereas among patients with more sustained hypertension, high ejection fractions may be associated with marked concentric LVH. Recent data indicate that echocardiographic detection of LVH identifies mildly hypertensive patients at significant risk, a finding that may aid identification of patients for drug treatment.