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Prevalence of electrocardiographic left ventricular hypertrophy in human hypertension: an updated review

Cuspidi, Cesare; Rescaldani, Marta; Sala, Carla; Negri, Francesca; Grassi, Guido; Mancia, Giuseppe

doi: 10.1097/HJH.0b013e32835726a3

Aim: Left ventricular hypertrophy (LVH) is a strong predictor of cardiovascular events in different clinical settings. We reviewed recent studies on the prevalence of hypertensive LVH, as assessed by ECG, in order to update our knowledge about this marker of cardiac organ damage in human hypertension.

Design: A MEDLINE search using the key words ‘ LVH ’, ‘hypertension’, ‘ECG’, ‘cardiac organ damage’ and ‘cardiac hypertrophy’ was performed in order to identify relevant articles. Full articles published in English language in the last decade (1 January 2000 to 31 December 2010) reporting studies in adult or elderly individuals, were considered.

Results: A total of 26 studies, including 40 444 untreated and treated individuals (85% whites, 47% men, 32% obese, 28% diabetics and 22% patients with cardiovascular disease) were considered. LVH was defined by 15 criteria (seven studies used two or more criteria, range 2-7); LVH prevalence consistently varied among studies (0.6-40.0%) with an average of 18% in the pooled population. A sex-based analysis in five out of 26 studies (12 084 patients) showed an average prevalence of LVH of 24% in men and 16% in women (odds ratio 1.38, 95% CI 0.91-2.09, P = 0.11).

Conclusion: Our analysis shows that LVH, as assessed by ECG, is present in a relevant fraction of the hypertensive population; these data highlight the role of ECG as a first-line examination for identifying subclinical organ damage and optimizing blood pressure control in hypertensive patients.

aDepartment of Clinical Medicine and Prevention, University of Milano-Bicocca

bIstituto Auxologico Italiano, Milano

cDepartment of Clinical Sciences and Community Health, University of Milano and, Fondazione Policlinico di Milano

dCentro Interuniversitario di Fisiologia Clinica e Ipertensione, University of Milano

eIRCCS Istituto di Ricerca a Carattere Scientifico Multimedica, Sesto San Giovanni, Milano, Italy

Correspondence to Professor Cesare Cuspidi, Istituto Auxologico Italiano, Clinical Research Unit, Viale della Resistenza 23, Meda 20036, Italy. Tel: +39 0362 772433; fax: +39 0362 772416; e-mail:

Abbreviations: BP, blood pressure; CIs, confidence intervals; LVH, left ventricular hypertrophy; ORs, odds ratios

Received 31 December, 2011

Revised 3 April, 2012

Accepted 19 June, 2012

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.