Cardiac hypertrophy and hypertension.

: The epidemiology of left ventricular hypertrophy (LVH) in hypertension has been extensively studied and its importance as a cardiovascular risk factor is established. Significant advances in recent years have also occurred in pathophysiology, detection of LVH, and in management including regression of hypertrophy. Advances in pathophysiology have demonstrated that a number of trophic factors such as stretch, angiotensin II and stimulation of the sympathetic nervous system contribute towards the hypertrophy of the myocyte. In addition, it is important to emphasise factors such as aldosterone and angiotensin which contribute towards the proliferation of fibroblasts. The mechanisms involved in the increased mortality in patients with left ventricular hypertrophy remain to be determined, but myocardial ischaemia, left ventricular dysfunction and a propensity to ventricular arrhythmias have all been studied in detail. Echocardiography is a more reliable method for detecting LVH than ECG, but these investigations should be regarded as complementary rather than one being performed to the exclusion of the other. It remains unclear as to whether regression of LVH specifically contributes to a reduction in overall cardiovascular risk, but the key point seems to be optimal control of blood pressure, and only with further clinical trials will the exact impact of regression of LVH on morbidity and mortality be known.