Influence of different echocardiographic criteria for detection of left ventricular hypertrophy on cardiovascular risk stratification in recently diagnosed essential hypertensives.

Background: Hypertensive patients with left ventricular hypertrophy (LVH) need a prompter and more intensive pharmacological treatment than subjects without evidence of cardiac involvement. So the detection of LVH plays an important role for decision-making in hypertensives. Objective: To evaluate the impact of different echocardiographic criteria to define LVH in a more precise stratification of absolute cardiovascular risk in hypertensives without target organ damage (TOD) as assessed by routine investigations. Methods: A total of 100 never treated patients with grade 1 and 2 essential hypertension (53 men, 47 women, age 44 ± 12 years) referred for the first time to our outpatient clinic were included in the study. They underwent the following procedures: (1) family and personal medical history, (2) clinic blood pressure (BP) measurement, (3) routine blood chemistry and urine analysis, (4) electrocardiogram, (5) echocardiogram. Risk was stratified according to the criteria suggested by the 1999 WHO-ISH guidelines. TOD was initially evaluated by routine procedures only, and subsequently reassessed by using six different echocardiographic criteria to recognise LVH: (a) left ventricular mass index (LVMI) <120 g/m2 in men and 100 g/m2 in women; (b) 125 g/m2 in men and 110 g/m2 in women; (c) 134 g/m2 in men and 110 g/m2 in women; (d) 125 g/m2 in men and 125 g/m2 in women; (e) 51 g/m2.7 in men and 47 g/m2.7 in women; (f) 126 g/m in men and 105 g/m in women. Results: According to the first classification based on routine investigations, 46% were low risk and 54% were medium risk patients. Significant changes in risk stratification were obtained when LVH was assessed by echocardiography. A percentage of patients, ranging from 9 (f) to 25% (d), were found to having LVH according to different criteria, and consequently moved from low and medium risk strata to high risk stratum. Conclusions: The detection of LVH by echocardiography allowed a much more accurate identification of high risk patients. In particular our results suggest that: (1) cardiovascular risk stratification only based on a simple routine work-up can often underestimate overall risk; (2) a better standardisation in defining LVH is needed, considering that the impact of cardiac hypertrophy on risk stratification is markedly dependent on the echocardiographic criteria used to diagnose it.