Left ventricular hypertrophy as a surrogate end-point in hypertension

Objectives: To examine the adequacy of available evidence that left ventricular hypertrophy (LVH) and its regression influence the rate of cardiovascular events in hypertension Design and Methods: Statistical, epidemiologic and treatment trial literature concerning ECG and echocardiographic LVH was reviewed to address the above question. Results: Results of 7 electrocardiographic and 10 echocardiographic studies (total n about 20,000 subjects) show consistently higher risks of morbid events in individuals with than without LVH (odds ratios 1.4 to 5.4). Available data (5 studies, 1,544 subjects) suggest that morbid events occur in higher proportions of individuals in whom LVH progresses (13 to 59%) than regresses (7 to 12%). Conclusions: Strict criteria to establish LVH as a fully adequate surrogate end-point for morbid events in hypertension are being increasingly satisfied by mounting evidence, but the independence of the relation of LVH change to prognosis from blood pressure or other factors has not yet been fully established.