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[Detection of left ventricular hypertrophy in arterial hypertension]
1Service de cardiologie, hôpital Saint-André, Bordeaux.
Insights
Left ventricular hypertrophy (LVH) can be treated independently of blood pressure. However, routine echocardiography for all hypertensive patients is not yet recommended due to diagnostic limitations and unproven prognostic benefits.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Imaging
Context:
- Left ventricular hypertrophy (LVH) is a significant risk factor in hypertension.
- The HYCAR study suggests LVH can be treated independently of blood pressure.
- Current diagnostic and follow-up methods for LVH have limitations.
Purpose:
- To evaluate the utility of routine echocardiography for diagnosing and monitoring LVH in hypertensive patients.
- To assess whether independent LVH reversibility improves patient prognosis.
- To determine the future role of echocardiography in hypertension management.
Summary:
- Echocardiography is more sensitive than electrocardiography for LVH but has limitations in image acquisition and measurement reproducibility.
- Current criteria for diagnosing LVH are subject to criticism.
- The prognostic value of independently reversing LVH remains to be demonstrated.
Impact:
- Findings suggest routine echocardiography for hypertensive patients is premature.
- Further research is needed to establish the clinical value of echocardiography in managing LVH.
- This study highlights the need for improved diagnostic tools and treatment strategies for LVH in hypertension.
Abstract:
Left ventricular hypertrophy is an important risk factor in hypertension and the results of the HYCAR study confirm that it is possible to treat this risk factor independently of an action on the blood pressure. Should systematic echocardiography be performed in every hypertensive patient to diagnose left ventricular hypertrophy and follow up its outcome with treatment? This attitude seems to be premature for two reasons. Firstly, echocardiography, though much more sensitive than electrocardiography for diagnosing left ventricular hypertrophy, has a number of limitations. Good recordings cannot be obtained in all patients; even under the best conditions of reproducibility, the measurement of left ventricular mass is not excellent and does not allow reliable individual follow-up of treatment; even the criteria of left ventricular hypertrophy used at present are open to criticism. Secondly, it remains to be shown whether the reversibility of left ventricular hypertrophy, independently of lowering the blood pressure, improves the prognosis of the hypertensive patient. The intensive research into this problem, further stimulated by the encouraging results of the HYCAR study, should help define the role and value of echocardiography in the future management of hypertension.