Left ventricular hypertrophy detection and body mass index in essential hypertension

Background and aim. Weight and height are two major determinants of left ventricular mass (LVM); the anthropometric parameter to which LVM should be normalized remains, however, debated. In a population of hypertensives, we compared the prevalence of left ventricular hypertrophy (LVH) defined by two indexation criteria of LVM in different subgroups of body mass index (BMI). Methods. A total of 4468 essential hypertensives included in the Evaluation of Target Organ Damage in Hypertension (ETODH), were divided in four groups according to BMI thresholds: lean (BMI2, 4.5%), normal (20-24.9 kg/m², 36.5%), overweight (25-29.9 kg/m², 41.9%) and obese (≥30 kg/m², 17.1%). All patients underwent quantitative echocardiography; LVH was defined by two criteria of LVM indexation: (A) ≥116 g/m² in men and ≥96 g/m² in women; (B) ≥49 g/m ^2.7 in men and ≥45 g/m^2.7 in women. Results. Overall, 44.9% of the patients were found to have LVH by criterion A, 48.2% by criterion B and 37.0% by both criteria. Prevalence rates of LVH in the four BMI groups were 34.3%, 40.5%, 47.3%, 53.9% by criterion A, 19.8%, 37.0%, 53.6%, 69.7% by criterion B, and 14.2%, 30.9%, 41.5%, 47.8% by both criteria, respectively (p at least 2.7 compared with body surface area (BSA), whereas the opposite trend occurs in normal weight/lean hypertensives. Thus, the risk related to LVH is underestimated when the LVH/height^2.7 criterion is applied to lean/normal weight individuals and the LVH/BSA criterion in overweight/obese individuals.