Prevalence and determinants of left ventricular hypertrophy and remodelling patterns in hypertensive patients: the St. Petersburg study

Abstract

Objective: The primary aim of the present study was to determine the prevalence of left ventricular hypertrophy (LVH) in hypertensive patients with the use of different threshold values and also to assess the distribution of left ventricular (LV) geometry patterns verified by two different methods of relative wall thickness (RWT) calculation. The secondary aim was to evaluate the impact of different demographic determinants into prevalence of LVH and remodelling patterns. Patients and methods: A cross‐sectional study in a population‐based sample of 734 essential hypertensives from the primary care clinic was undertaken. Echocardiography was performed and analysed by trained observers. The LV posterior wall thickness (PWd), interventricular septum (IVSd) and LV mass index (LVMI) were measured. The following criteria for LVH definition were used: LVMI >125 g/m ² and 134/110 g/m ² , and >131/110 and 116/104 g/m ² in males/females, respectively. The RWT was calculated as a 2PWd/LVDD or PWd + IVSd/LVDD, where LVDD is the LV internal dimension at the end of diastole. The values exceeding 0.45 were considered evidence for concentric remodelling. Results: Prevalence of LVH ranged from 52.2 to 72.2% by the use of different threshold for LVH definition. It was shown that the LVH estimation without sex‐specific criteria underestimates the prevalence of LVH in women and overestimates it in men. The prevalence of concentric LVH and concentric remodelling was higher when the IVSd was included in the RWT calculation. Only one‐quarter of patients were free from morphological alterations and eccentric LVH was as frequently observed as concentric LVH. Sex, obesity stage and type as well as hypertension level and duration contributed to LVH level and remodelling pattern. Conclusions: The use of different threshold values can significantly influence the assessment of prevalence of LVH in hypertension. The “mild” criteria, to our opinion, can overestimate the prevalence of structural LV remodelling, while implementation of sex‐specific criteria for the definition of LVH increases the sensitivity of the method. In any way, eccentric LVH is as common for hypertension as a concentric LVH, the proportion of the latter increasing with age and more frequently observed in males. Concomitant obesity, in particular abdominal, significantly increases LVH prevalence.

• hypertension
• left ventricular hypertrophy
• remodelling