Prevalence of left ventricular hypertrophy and carotid thickening in a large selected hypertensive population: Impact of different echocardiographic and ultrasonographic diagnostic criteria

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/m(2) in women and 120 g/m(2) in men, 2 - 2 2 - 2 2 (b) 110 g/m(2) in women and 125 g/m(2) in men, (c) 110 g/m(2) in women and 134 g/m(2) in men, (d) 125 g/m(2) in both sexes, (e) 47 g/h(2.7) in women and 51 g/h(2.7) 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) greater than or equal to0.8 mm; (b) greater than or equal to0.9 mm; (c) greater than or equal to1.0 min 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/height(2.7), 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.