What does this research mean for the field?

The estimated prevalence of left ventricular hypertrophy and carotid intima-media thickening in hypertensive patients varies widely depending on the specific diagnostic criteria and partition values used, highlighting a critical need for standardized definitions. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2001

Prevalence of Left Ventricular Hypertrophy and Carotid Thickening in a Large Selected Hypertensive Population: Impact of Different Echocardiographic and Ultrasonographic Diagnostic Criteria

Structured PICO

Does the choice of diagnostic criteria significantly impact the estimated prevalence of left ventricular hypertrophy and carotid intima-media thickening in hypertensive patients?

Population

640 consecutive hypertensive patients referred to an outpatient hypertension unit (611 analyzed with sufficient quality)

Intervention

Echocardiographic and ultrasonographic evaluation using 6 different criteria for left ventricular hypertrophy (LVH) and 3 different criteria for carotid intima-media (IM) thickening

Outcome

Prevalence of left ventricular hypertrophy (LVH) and common carotid artery intima-media (IM) thickeningsurrogate

The estimated prevalence of target organ damage (LVH and carotid IM thickening) in hypertensive patients is highly dependent on the diagnostic criteria used, highlighting the need for improved standardization.

Abstract

BACKGROUND: Left ventricular hypertrophy (LVH) and increased carotid intima-media thickness (IMT) represent independent risk factors for cardiovascular disease. OBJECTIVE: To evaluate the prevalence of echocardiographic LVH and common carotid artery (CCA) intima-media (IM) thickening by different criteria in a large sample of hypertensive patients referred to our Hypertension Clinic. METHODS: Echocardiograms and ultrasonographic carotid examinations have been performed in 640 consecutive hypertensives referred to our outpatient's hypertension unit. LVH was diagnosed using six different criteria, when left ventricular mass index (LVMI) exceeded (a) 100 g/m2 in women and 120 g/m2 in men, (b) 110 g/m2 in women and 125 g/m2 in men, (c) 110 g/m2 in women and 134 g/m2 in men, (d) 125 g/m2 in both sexes, (e) 47 g/h2.7 in women and 51 g/h2.7 in men, (f) 105 g/h in women and 126 g/h in men. Thickening of CCA IM was identified using three partition values; when IMT was (a) > or =0.8 mm; (b) >0.9 mm: (c) > or = 1.0 mm in both sexes. RESULTS: Echocardiographic and ultrasonographic examinations of sufficient quality to be analysed were obtained in 611 patients (95.2%). Prevalence of LVH ranged from 18.6% (d) to 42.2% (f) and was significantly higher in men than in women by criteria (d) and (e), but slightly higher in women when using criteria (a) and (c). Eccentric hypertrophy was the most frequent type of LVH independently of the criteria used. Prevalence of IM thickening ranged from 14.7% (c) to 44.2% (a). Significant correlations between left ventricular mass (LVM)/body surface area, LVM/height and LVM/height2.7, and carotid IM thickness were found (r=0.41; p <0.0001; r=0.31; p <0.0001; r = 0.30; p <0.0001, respectively). CONCLUSION: The prevalence of LVH and CCA IM thickening in hypertensive patients is markedly dependent on the partition values used to define these markers of target organ damage. Considering the pivotal role of LVH and CCA IM thickening in assessing the global cardiovascular risk profile in hypertensives, improved standardization in defining LVH and carotid IM thickening is needed.

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