ESPITE SUBSTANTIAL BENefits from lowering blood pressure (BP), conventional treatment does not normalize the risk of major cardiovascular (CV) events in patients with hypertension. 1-5 Progress has been made in predicting risk of hypertension by evaluating preclinical CV disease. 6 Left ventricular hypertrophy (LVH), ie, pathologically increased left ventricular mass, independently predicts adverse outcomes in diverse populations, 7-12 including patients with hypertension. 7,11 These findings suggest that the level of left ventricular mass and mass reduction during treatment of hypertension may provide independent information about disease progression or control. This hypothesis has been supported by data from some, 13,14 but not other, 15,16 electrocardiographic studies. Echocardio-See also pp 2343 and 2396 and Patient Page.

Abstract-Left ventricular (LV) hypertrophy and concentric remodeling have been defined by using a variety of indexation methods and partition values (PVs) for LV mass and relative wall thickness (RWT). The effects of these methods on the distribution of LV geometric patterns in hypertensive subjects remain unclear. RWT was calculated by either 2ϫend-diastolic posterior wall thickness (PWT)/enddiastolic LV internal dimension (LVID) or end-diastolic interventricular septum dimensionϩend-diastolic PWT/enddiastolic LVID. LV hypertrophy or remodeling was present in 63% to 86% of subjects, and LV hypertrophy was present in 42% to 77%. By any index, eccentric hypertrophy was the common LV geometric pattern. Use of interventricular septum dimensionϩPWT/LVID to calculate RWT slightly increased the prevalence of normal geometry and eccentric hypertrophy compared with the use of 2ϫPWT/LVID. Subjects with LV hypertrophy identified by only LV mass/height 2.7 PV 49.2/46.7 were more obese, whereas those identified by only LV mass/body surface area PV 116/104 were taller and thinner than those in the 2 concordant groups with or without LV hypertrophy by both criteria. By either criterion, there were no significant differences between different LV geometric patterns in clinical cardiovascular disease. Hypertensive patients with LV hypertrophy by ECG have a high prevalence of geometric abnormalities, especially eccentric hypertrophy, irrespective of method of indexation or PV. LV mass indexation by body surface area or height 2.7 identifies lean and obese subjects, respectively. We found no difference in prevalent cardiovascular disease in subjects identified by either criterion, suggesting a similar high risk. (Hypertension. 2000;35:6-12.) Key Words: echocardiography Ⅲ electrocardiography Ⅲ hypertrophy, left ventricular Ⅲ hypertension, essential L eft ventricular (LV) hypertrophy, as determined by echocardiography, has been shown to be a strong predictor of adverse prognosis independent of and, in most instances, stronger than conventional risk factors. 1-3 On the basis of distributions of indexed echocardiographic LV mass in normal populations, LV hypertrophy has been identified by calculation of LV mass that has been indexed for body surface area (BSA) 1,4 -6 or for BSA 1.5 , 7 height, height 2.0 , 8 height 2.13 , 9 height 2.7 , 7,9,10 or height 3.0 . 11 The combination of LV mass index (LVMI) and relative wall thickness (RWT) has been used to identify 3 different abnormal LV geometric patterns. 2,12 RWT has been calculated either as the ratio of 2ϫposterior wall thickness/LV internal diameter 13 or as the ratio of (interventricular septalϩposterior wall thickness)/LV internal diameter. 14 The relation between LVMI and RWT seems important in view of the fact that several studies have shown that stratification by different geometric patterns gives valuable information concerning morbidity and mortality. In these studies, subjects with concentric hypertrophy (ie, increased RWT and LVMI) had the highest incidence of cardiovascula...

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