Left ventricular hypertrophy as an independent predictor of acute cerebrovascular events in essential hypertension

Background-It is uncertain whether left ventricular hypertrophy (LVH) confe rs an increased risk for cerebrovascular disease in apparently healthy pati ents with essential hypertension. Methods and Results-A total of 2363 initially untreated hypertensive patien ts (mean age 51 +/- 12 years, 47% women) free of previous cardiovascular di sease were followed up for up to 14 years (mean 5 years). At entry, all pat ients underwent diagnostic tests, including ECG, echocardiography, and 24-h our ambulatory blood pressure (BP) monitoring. At entry, the prevalence of LVH was 17.6% by ECG (Perugia score) and 23.7% by echocardiography (LVM > 1 25 g/m(2)). Over the subsequent years, 105 patients experienced a first str oke or transient ischemic attack. The cerebrovascular event rate was higher among patients with LVH at entry, diagnosed by either ECG or echocardiogra phy, than among those without hypertrophy (both P <0.01). After control for the significant influence of age, sex, diabetes, and 24-hour mean ambulato ry BP, LVH by ECG conferred an increased risk for cerebrovascular events (r elative 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 I SID (29 g/m(2)), there was a sign ificant independent increase in the risk for cerebrovascular events (RR 1.3 1; 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 fa ctors.