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(Circulation. 2001;104:2039.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Left Ventricular Hypertrophy as an Independent Predictor of Acute Cerebrovascular Events in Essential Hypertension

Paolo Verdecchia, MD; Carlo Porcellati, MD; Gianpaolo Reboldi, MD PhD, MSc; Roberto Gattobigio, MD; Claudia Borgioni, MD; Thomas A. Pearson, MD MPH; Giuseppe Ambrosio, MD PhD

From the Dipartimento Malattie Cardiovascolari, Università di Perugia, Ospedale Silvestrini (P.V., C.P., C.B., G.A.), and the Dipartimento di Medicina Interna, University of Perugia (G.R.); Ospedale Beato G. Villa, Città della Pieve (R.G.); and Department of Community and Preventive Medicine (T.A.P.), University of Rochester, Rochester, NY.

Correspondence to Dr Paolo Verdecchia, Dipartimento Malattie Cardiovascolari, Università di Perugia, Ospedale Silvestrini, S Andrea delle Fratte, 06122 Perugia, Italy. E-mail verdec{at}tin.it

Background— It is uncertain whether left ventricular hypertrophy (LVH) confers an increased risk for cerebrovascular disease in apparently healthy patients with essential hypertension.

Methods and Results— A total of 2363 initially untreated hypertensive patients (mean age 51±12 years, 47% women) free of previous cardiovascular disease were followed up for up to 14 years (mean 5 years). At entry, all patients underwent diagnostic tests, including ECG, echocardiography, and 24-hour ambulatory blood pressure (BP) monitoring. At entry, the prevalence of LVH was 17.6% by ECG (Perugia score) and 23.7% by echocardiography (LVM >125 g/m²). Over the subsequent years, 105 patients experienced a first stroke or transient ischemic attack. The cerebrovascular event rate was higher among patients with LVH at entry, diagnosed by either ECG or echocardiography, than among those without hypertrophy (both P<0.01). After control for the significant influence of age, sex, diabetes, and 24-hour mean ambulatory BP, LVH by ECG conferred an increased risk for cerebrovascular events (relative risk [RR] 1.79; 95% CI 1.17 to 2.76). LVH by echocardiography also conferred a higher risk for cerebrovascular events (RR 1.64; 95% CI 1.07 to 2.68). For each increase in LV mass of 1 SD (29 g/m²), there was a significant independent increase in the risk for cerebrovascular events (RR 1.31; 95% CI 1.09 to 1.58).

Conclusions— In apparently healthy patients with essential hypertension, LVH diagnosed by ECG or echocardiography confers an excess risk for stroke and transient ischemic attack independently of BP and other individual risk factors.

Key Words: hypertension • stroke • hypertrophy • prognosis • blood pressure • epidemiology

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