Identification of left ventricular hypertrophy: chest roentgenography, echocardiography, and electrocardiography.

The assessment of cardiac anatomy and function in the hypertensive population is an important aspect of the total evaluation of this patient group. The finding of cardiomegaly requires elucidation of its etiology. The finding of left ventricular hypertrophy on electrocardiogram is a harbinger for potential catastrophe, but other studies have indicated that the electrocardiogram may miss a substantial portion of the left ventricular hypertrophy which can be shown by echocardiogram: a normal electrocardiogram does not mean left ventricular hypertrophy is absent. Subtle changes on the electrocardiogram suggestive of left atrial abnormality must be pursued with echocardiography to eliminate the possibility of changes in left ventricular compliance or left ventricular hypertrophy. The prevention of left ventricular hypertrophy (or regression thereof) should be of major consideration to the clinician as he initiates antihypertensive therapy. The finding of left ventricular hypertrophy at the time of diagnosis tells the physician to implement aggressive and effective antihypertensive therapy. The absence of these findings should never imply, however, that therapy be withheld until indices of early or frank left ventricular hypertrophy are apparent.