Left ventricular hypertrophy and mortality in ethnic minority groups in the UK: e-ECHOES study
Related Experiment Video
Updated: Jul 16, 2025
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Eduard Shantsila1,2, Alena Shantsila2, Nefyn Williams1,2
1Department of Primary Care and Mental Health, University of Liverpool.
Insights
Hypertension is highly prevalent and often undiagnosed in UK South Asian and African-Caribbean communities. Left ventricular hypertrophy (LVH) is common and linked to increased mortality in these populations.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Hypertension is a major modifiable cardiovascular risk factor, yet its prevalence and impact, particularly Left Ventricular Hypertrophy (LVH), remain understudied in South Asian and African-Caribbean communities in the UK.
- LVH, a marker of target organ damage in hypertension, is crucial for assessing cardiovascular risk and prognosis.
Purpose of the Study:
- To assess the prevalence of LVH in South Asian and African-Caribbean populations residing in the UK.
- To determine the impact of LVH on all-cause and cardiovascular mortality in these ethnic groups.
- To estimate the prevalence of undiagnosed hypertension within these communities.
Main Methods:
- The study utilized data from the prospective UK community Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES), including 3200 South Asians and 1858 African-Caribbeans aged 45 years and above.
- Left ventricular mass index (LVMI) was calculated via echocardiography to diagnose LVH.
- Cox regression analysis was employed to assess the association between LVH and mortality outcomes.
Main Results:
- LVH was prevalent in 49% of South Asians and 64% of African-Caribbeans. A significant proportion (45% in South Asians, 32% in African-Caribbeans) with LVH were undiagnosed hypertensives.
- LVH was independently associated with increased all-cause mortality in South Asians (HR 1.38) and borderline associated in African-Caribbeans (HR 1.57).
- LVH was significantly associated with cardiovascular mortality in South Asians (HR 2.64) but not in African-Caribbeans (HR 1.82). Projected hypertension prevalence was 82% in South Asians and 78.5% in African-Caribbeans, with substantial undiagnosed rates.
Conclusions:
- UK South Asians and African-Caribbeans exhibit high rates of hypertension, frequently undiagnosed and poorly controlled.
- LVH is a common finding in these ethnic groups and is associated with increased mortality, highlighting the need for targeted screening and management strategies.
Objectives:
Hypertension is the key modifiable cardiovascular risk factor but is underdiagnosed, and its scale in South Asian and African-Caribbean communities is unknown. Left ventricular hypertrophy (LVH) is a measure of target organ damage in uncontrolled hypertension. The study assesses LVH prevalence in South Asian and African-Caribbean communities and its impact on mortality.
Method:
This study is based on the large prospective UK community Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES, age ≥45 years). Left ventricular mass index (LVMI) was calculated using echocardiography to establish LVH. The predictive value of LVH all-cause and cardiovascular mortality was assessed using Cox regression.
Results:
The study included 3200 South Asians (age 59 ± 10 years, 52% women, 45% had a history of hypertension, 5.8 ± 1.0-year follow-up). LVH was found in 1568 (49%), of whom 45% did not have hypertension diagnosis. On Cox regression, LVH was independently associated with all-cause mortality [hazard ratio 1.38, 95% confidence interval (95% CI) 1.01-1.88], cardiovascular mortality (hazard ratio 2.64, 95% CI 1.21-3.73). The projected overall hypertension prevalence was 82%, undiagnosed hypertension prevalence 37%. The study included 1858 African-Caribbeans (age 62 ± 12, 45% women, 45% had history of hypertension, 5.1 ± 0.9-year follow-up). LVH was found in 1186 (64%), of whom 32% did not have hypertension diagnosis. LVH was borderline associated with all-cause mortality (hazard ratio 1.57, 95% CI 1.01-2.44), but not cardiovascular mortality (hazard ratio 1.82, 95% CI 0.80-4.16). The projected overall hypertension prevalence was 78.5%, and undiagnosed hypertension prevalence was 20.8%.
Conclusion:
UK South Asians and African-Caribbeans have a high prevalence of hypertension, which is often underdiagnosed and poorly controlled.
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