[Left ventricular hypertrophy of hypertensive origin: classical concepts and recent data]

Left ventricular hypertrophy occurs in numerous hypertensive patients. It can be diagnosed by using echocardiography, whose sensibility (93%) and sensitivity (95%) are both excellent, provided the quality of the recordings is good enough (80%). Most often, left ventricular hypertrophy is a concentric one (relative wall thickness greater than 0.45). The determinants of hypertensive left ventricular hypertrophy are of mechanical and hormonal origin; Weber's and Brilla's recent findings suggest that the haemodynamic burden should be responsible for myocytes hypertrophy, whereas hormonal factors stimulate fibrosis proliferation. Although left ventricular hypertrophy is initially an adaptative process, it eventually results in numerous deleterious effects: arrhythmias, myocardial ischemia, left ventricular filling abnormalities. Left ventricular hypertrophy is now recognized as a powerful blood-pressure independent risk factor for cardio-vascular morbidity and mortality. Therefore, antihypertensive therapy must be aimed at reducing not only blood pressure but also left ventricular mass. Most of the published regression studies have however to be criticized from a methodologic standpoint.