[Detection of left ventricular hypertrophy in arterial hypertension]

Left ventricular hypertrophy is an important risk factor in hypertension and the results of the HYCAR study confirm that it is possible to treat this risk factor independently of an action on the blood pressure. Should systematic echocardiography be performed in every hypertensive patient to diagnose left ventricular hypertrophy and follow up its outcome with treatment? This attitude seems to be premature for two reasons. Firstly, echocardiography, though much more sensitive than electrocardiography for diagnosing left ventricular hypertrophy, has a number of limitations. Good recordings cannot be obtained in all patients; even under the best conditions of reproducibility, the measurement of left ventricular mass is not excellent and does not allow reliable individual follow-up of treatment; even the criteria of left ventricular hypertrophy used at present are open to criticism. Secondly, it remains to be shown whether the reversibility of left ventricular hypertrophy, independently of lowering the blood pressure, improves the prognosis of the hypertensive patient. The intensive research into this problem, further stimulated by the encouraging results of the HYCAR study, should help define the role and value of echocardiography in the future management of hypertension.