Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies

Abstract

Left-ventricular hypertrophy (LVH) is a cardinal manifestation of hypertensive organ damage associated with an increased cardiovascular (CV) risk. We reviewed recent literature on the prevalence of LVH, as assessed by echocardiography, in order to offer an updated information on the magnitude of subclinical alterations in LV structure in contemporary human hypertension. A MEDLINE search using key words ‘left ventricular hypertrophy’, ‘hypertension’, ‘echocardiography’ and ‘cardiac organ damage’ was performed in order to identify relevant papers. Full articles published in English language in the last decade, (1 January 2000–1 December 2010), reporting studies in adult or elderly individuals, were considered. A total of 30 studies, including 37 700 untreated and treated patients (80.3% Caucasian, 52.4% men, 9.6% diabetics, 2.6% with CV disease) were considered. LVH was defined by 23 criteria; its prevalence ranged from 36% (conservative criteria) to 41% (less conservative criteria) in the pooled population. LVH prevalence was not different between women and men (range 37.9–46.2 versus 36.0–43.5%, respectively). Eccentric LVH was more frequent than concentric hypertrophy (range 20.3–23.0 versus 14.8–15.8, respectively, P<0.05); concentric phenotype was found in a consistent fraction (20%) of both genders. Despite the improved management of hypertension in the last two decades, LVH remains a highly frequent biomarker of cardiac damage in the hypertensive population. Our analysis calls for a more aggressive treatment of hypertension and related CV risk factors leading to LVH.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1
Figure 2

References

  1. Diez J, Frohlich E . A translational approach to hypertensive heart disease. Hypertension 2010; 55: 1–8.

    Article  CAS  PubMed Central  Google Scholar 

  2. Frohlich E, Gonzales A, Diez J . Hypertensive left ventricular hypertrophy risk: beyond adaptive cardiomyocytic hypertrophy. J Hypertens 2011; 29: 17–26.

    Article  CAS  PubMed Central  Google Scholar 

  3. Kehat I, Molkentin JD . Molecular pathways underlying cardiac remodeling during pathophysiological stimulation. Circulation 2010; 122: 2727–2735.

    Article  PubMed Central  Google Scholar 

  4. Schmieder RE . The role of non-haemodynamic factors in the genesis of LVH. Nephron Dial Transplant 2005; 20: 2610–2612.

    Article  Google Scholar 

  5. de Simone G, Palmieri V, Bella JN, Celentano A, Hong Y, Oberman A et al. Association of left ventricular hypertrophy with metabolic risk factors: the HyperGEN study. J Hypertens 2002; 20: 323–331.

    Article  CAS  PubMed Central  Google Scholar 

  6. Vakili BA, Okin PM, Devereux RB . Prognostic implications of left ventricular hypertrophy. Am Heart J 2001; 141: 334–341.

    Article  CAS  Google Scholar 

  7. Bombelli M, Facchetti R, Carugo S, Madotto F, Arenare F, Quarti-Trevano F et al. Left ventricular hypertrophy increases cardiovascular risk independently of in and out-of office blood pressure values. J Hypertens 2009; 27: 2458–2464.

    Article  CAS  Google Scholar 

  8. Tsioufis C, Vezali E, Tsiachris D, Dimitriadis K, Taxiarchou E, Chatzis D et al. Left ventricular hypertrophy versus chronic renal disease as predictors of cardiovascular events in hypertension: a Greek 6-year-follow-up study. J Hypertens 2009; 27: 1705–1712.

    Article  Google Scholar 

  9. Pierdomenico SD, Cuccurullo F . Risk reduction after regression of echocardiographic left ventricular hypertrophy in hypertension: a meta-analysis. Am J Hypertens 2010; 23: 876–881.

    Article  PubMed Central  Google Scholar 

  10. Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009; 27: 2121–2156.

    Article  CAS  Google Scholar 

  11. Ruilope LM, Schmieder RE . Left ventricular hypertrophy and clinical outcomes in hypertensive patients. Am J Hypertens 2008; 21: 500–506.

    Article  Google Scholar 

  12. Fagard RH, Celis H, Thijs L, Wouters S . Regression of left ventricular mass by antihypertensive treatment. A meta-analysis of randomized comparative studies. Hypertension 2009; 54: 1084–1091.

    Article  CAS  PubMed Central  Google Scholar 

  13. Wachtell K, Bella JN, Liebson P, Gerdts E, Dahlof B, Aalto T et al. Impact of different partition values on prevalences of left ventricular hypertrophy and concentric geometry in a large hypertensive population. The LIFE Study. Hypertension 2000; 35: 6–12.

    Article  CAS  PubMed Central  Google Scholar 

  14. Saba MM, Ibrahim MM, Rizk H . Gender and the relationship between resting heart rate and left ventricular geometry. J Hypertens 2000; 19: 367–373.

    Article  Google Scholar 

  15. Cipriano C, Gosse P, Bemurat L, Mas D, Lemetayer P, T’Tela G et al. Prognostic value of left ventricular mass and its evolution during treatment in the Bordeaux cohort of hypertensive patients. Am J Hypertens 2001; 14: 524–529.

    Article  CAS  PubMed Central  Google Scholar 

  16. Verdecchia P, Carini G, Circo A, Dovellini E, Giovannini E, Lombardo M et al. Left ventricular mass and cardiovascular morbidity in essential hypertension: The MAVI Study. J Am Coll Cardiol 2001; 38: 1829–1935.

    Article  CAS  Google Scholar 

  17. Cuspidi C, Ambrosioni E, Mancia G, Pessina AC, Trimarco B, Zanchetti A . Role of echocardiography and carotid ultrasonography in stratifying risk in patients with essential hypertension: the Assessment of Prognostic Risk Observational Survey. J Hypertens 2002; 20: 1307–1314.

    Article  CAS  Google Scholar 

  18. Mancia G, Carugo S, Grassi G, Lanzarotti A, Schiavina R, Cesana G et al. Prevalence of left ventricular hypertrophy in hypertensive patients without and with blood pressure control: data from the PAMELA population. Hypertension 2002; 39: 744–749.

    Article  CAS  Google Scholar 

  19. Fesler P, Du Cailar G, Ribstein J, Mimran A . Left ventricular function in never-treated essential hypertension. J Am Soc Nephrol 2003; 14: 881–887.

    Article  PubMed Central  Google Scholar 

  20. Muiesan ML, Salvetti M, Monteduro C, Bonzi B, Paini A, Viola S et al. Left ventricular concentric geometry during treatment adversely affect cardiovascular prognosis in hypertensive patients. Hypertension 2004; 43: 731–738.

    Article  CAS  Google Scholar 

  21. Conrady AO, Rudomanov OG, Zaharov DV, Krutikov AN, Vahrameeva NV, Yakovleva OI et al. Prevalence and determinants of left ventricular hypertrophy and remodeling patterns in hypertensive patients: The St. Petersburg Study. Blood Press 2004; 13: 101–109.

    Article  CAS  PubMed Central  Google Scholar 

  22. de Simone G, Kizer JR, Chinali M, Roman MJ, Bella JN, Best LG et al. Normalization for body size and population attributable risk of left ventricular hypertrophy. Am J Hypertens 2005; 18: 191–196.

    Article  Google Scholar 

  23. Eguchi K, Kario K, Hoshide S, Ishikawa J, Morinari M, Shimada K . Type 2 diabetes is associated with left ventricular concentric remodeling in hypertensive patients. Am J Hypertens 2005; 18: 23–29.

    Article  PubMed Central  Google Scholar 

  24. Viazzi F, Parodi D, Leoncini G, Parodi A, Falqui V, Ratto E et al. Serum uric acid and target organ damage in primary hypertension. Hypertension 2005; 45: 991–996.

    Article  CAS  PubMed Central  Google Scholar 

  25. Glorioso N, Filigheddu F, Pinna Parpaglia P, Soro A, Troffa C, Argiolas G et al. 11beta-hydroxysteroid dehydrogenase type 2 activity is associated with left ventricular mass in essential hypertension. Eur Heart J 2005; 26: 498–504.

    Article  CAS  PubMed Central  Google Scholar 

  26. Verdecchia P, Angeli F, Gattobigio R, Sardone M, Porcellati C . Asymptomatic left ventricular systolic dysfunction in essential hypertension: prevalence, determinants, and prognostic value. Hypertension 2005; 45: 412–418.

    Article  CAS  PubMed Central  Google Scholar 

  27. de Simone G, Kitzman DW, Chinali M, Oberman A, Hopkins PN, Rao DC et al. Left ventricular concentric geometry is associated with impaired relaxation in hypertension: the HyperGEN study. Eur Heart J 2005; 26: 1039–1145.

    Article  PubMed Central  Google Scholar 

  28. Schillaci G, Pirro M, Pucci G, Mannarino MR, Gemelli F, Siepi D et al. Different impact of the metabolic syndrome on left ventricular structure and function in hypertensive men and women. Hypertension 2006; 47: 881–886.

    Article  CAS  Google Scholar 

  29. Zanchetti A, Cuspidi C, Comarella L, Agabiti-Rosei E, Ambrosioni E, Chiarello M et al. Left ventricular diatolic dysfunction in elderly hypertensives: results of the APROS-diadys study. J Hypertens 2007; 25: 2158–2167.

    Article  CAS  Google Scholar 

  30. Peterson GE, de Backer T, Gabriel A, Ilic V, Vagaonescu T, Appel LJ et al. Prevalence and correlates of left ventricular hypertrophy in the African American Study of kidney disease cohort study. Hypertension 2007; 50: 1033–1039.

    Article  CAS  Google Scholar 

  31. Mulè G, Cusimano P, Nardi E, Cottone S, Geraci C, Palermo A et al. Relationship between metabolic syndrome and left ventricular mass in hypertensive patients: does sex matter? J Hum Hypertens 2008; 22: 788–795.

    Article  PubMed Central  Google Scholar 

  32. Tsioufis CP, Tsiachris DL, Selima MN, Dimitriadis KS, Thomopoulos CG, Tsiliggiris DC et al. Impact of waist circumference on cardiac phenotype in hypertensives according to gender. Obesity 2008; 17: 177–182.

    Article  PubMed Central  Google Scholar 

  33. Iwashima Y, Horio T, Kamide K, Tokudome T, Yoshihara F, Nakamura S et al. Additive interaction of metabolic syndrome on cardiac hypertrophy, and risk of cardiovascular disease in hypertension. Am J Hypertens 2010; 23: 290–298.

    Article  PubMed Central  Google Scholar 

  34. Yasuno S, Ueshima K, Oba K, Fujimoto A, Ogihara T, Saruta T et al. Clinical significance of left ventricular hypertrophy and changes in left ventricular mass in high risk hypertensive patients: a subanalysis of the Candesartan Antihypertensve Survival Evaluation in Japan Trial. J Hypertens 2009; 27: 1705–1712.

    Article  CAS  PubMed Central  Google Scholar 

  35. Castelpoggi CH, Pereira VS, Fiszman R, Cardoso CRL, Muxfeldt ES, Salles GF . A blunted decrease in nocturnal blood pressure is independently associated with increased aortic stiffness in patients with resistant hypertension. Hypertens Res 2009; 32: 591–596.

    Article  PubMed Central  Google Scholar 

  36. Cuspidi C, Giudici V, Lonati L, Sala C, Valerio C, Mancia G . Left ventricular hypertrophy detection and body mass index. Blood Press 2010; 19: 337–343.

    Article  PubMed Central  Google Scholar 

  37. Cuspidi C, Giudici V, Negri F, Sala C, Mancia G . Left ventricular geometry, ambulatory blood pressure and extra-cardiac organ damage in untreated essential hypertension. Blood Press Monit 2010; 15: 124–131.

    Article  PubMed Central  Google Scholar 

  38. de Simone G, Izzo R, Chinali M, De Marco M, Casalnuovo G, Rozza F et al. Does information on systolic and diastolic function improve prediction of a cardiovascular event by left ventricular hypertrophy in arterial hypertension? Hypertension 2010; 56: 99–104.

    Article  CAS  PubMed Central  Google Scholar 

  39. Cuspidi C, Negri F, Muiesan ML, Capra A, Lonati L, Milan A et al. Prevalence and severity of echocardiographic left ventricular in hypertensive patients in clinical practice. Blood Press 2010; 20: 3–9.

    Article  PubMed Central  Google Scholar 

  40. Noheria A, Mosley TH, Kullo IJ . Association of serum osteoprotegerin with left ventricular mass in African-American adults with hypertension. Am J Hypertens 2010; 23: 767–774.

    Article  CAS  PubMed Central  Google Scholar 

  41. Chahal NS, Lim TK, Jain P, Chambers JC, Kooner JS, Senior R . New insights into the relationship of left ventricular geometry and left ventricular mass with cardiac function: a population study of hypertensive subjects. Eur Heart J 2010; 31: 588–594.

    Article  PubMed Central  Google Scholar 

  42. Cerasola G, Nardi E, Mul G, Palermo A, Cusumano P, Guarneri M et al. Left ventricular mass in hypertensive patients with mild-to-moderate reduction of renal function. Nephrology 2010; 15: 203–210.

    Article  PubMed Central  Google Scholar 

  43. Devereux RB, Reickek N . Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 1977; 55: 613–618.

    Article  CAS  Google Scholar 

  44. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Camo E, Sachs I et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57: 450–458.

    Article  CAS  PubMed Central  Google Scholar 

  45. Cuspidi C, Esposito A, Negri F, Sala C, Masaidi M, Giudici V et al. Studies on left ventricular hypertrophy regression: a clear message for the clinician? Am J Hypertens 2008; 21: 458–463.

    Article  PubMed Central  Google Scholar 

  46. Gidding SS . Controversies in the assessment of left ventricular mass. Hypertension 2010; 56: 26–28.

    Article  CAS  PubMed Central  Google Scholar 

  47. Levy D, Savage DD, Garrison RJ, Anderson KM, Kannel WB, Castelli WP . Echocardiographic criteria for left ventricular hypertrophy: the Framingham Heart Study. Am J Cardiol 1987; 59: 956–960.

    Article  CAS  PubMed Central  Google Scholar 

  48. Okin PM, Gerdts E, Kjeldsen SV, Julius S, Edelman JM, Daholf B et al. Gender difference in regression of electrocardiographic left ventricular hypertrophy during antihypertensive therapy. Hypertension 2008; 52: 100–106.

    Article  CAS  PubMed Central  Google Scholar 

  49. Henry RMA, Kamp O, Kostense PJ, Spijkerman AMW, Dekker MD, Nijpels G et al. Mild renal insufficiency is associated with increased left ventricular mass in men, but not in women: an arterial stiffness-related phenomenon- The Hoorn Study. Kidney Int 2005; 68: 673–679.

    Article  CAS  PubMed Central  Google Scholar 

  50. Coca A, Gabriel R, de la Figuera M, Lopez-Sendon JL, Fernandez R, Sagastagoitia JD et al. On behalf the VITAE Investigators. The impact of different echocardiographic diagnostic criteria on the prevalence of left ventricular hypertrophy in essential hypertension. J Hypertens 1999; 17: 1471–1480.

    Article  CAS  Google Scholar 

  51. Ghali JK, Liao Y, Cooper RS . Influence of left ventricular geometric patterns on prognoss in patients with r without coronary artery disease. J Am Coll Cardiol 1998; 31: 1635–1640.

    Article  CAS  PubMed Central  Google Scholar 

  52. Milani RV, Lavie CJ, Mehera MR, Ventura HO, Kartz JD, Messerli F . Left ventricular geometry and survival in patients with normal left ventricular ejection fraction. Am J Cardiol 2006; 97: 959–963.

    Article  Google Scholar 

  53. Volpe M, Tocci G, Trimarco B, Agabiti-Rosei E, Borghi C, Ambrosioni E et al. Blood pressure control in Italy: results of recent surveys on hypertension. J Hypertens 2007; 25: 1491–1498.

    Article  CAS  PubMed Central  Google Scholar 

Download references

Acknowledgements

We are grateful to Gil F Salles for providing the data of his study.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to C Cuspidi.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Cuspidi, C., Sala, C., Negri, F. et al. Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies. J Hum Hypertens 26, 343–349 (2012). https://doi.org/10.1038/jhh.2011.104

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2011.104

Keywords

  • left ventricular hypertrophy
  • echocardiography
  • target organ damage

This article is cited by

Search

Quick links