Treatment of essential hypertension today. The role of beta blockers, calcium antagonists, and ACE inhibitors.

The greater sensitivity of echocardiography than electrocardiography has revealed left ventricular hypertrophy (LVH) to occur in a significant minority of patients with systemic hypertension, with the exact prevalence dependent both on how a population is selected and on the sex. race, and possibly age composition of its members. LVH is more closely related to blood pressure recorded in the patient's natural setting during normal activity or exercise--whether measured by portable recorder or home manometer--than to blood pressure measured by the physician. A subgroup of patients with mild essential hypertension exhibit high cardiac output and evidence of supernormal myocardial contractility in the absence of LVH; whereas amongst patients with more sustained hypertension, LVH may be either concentric (associated with high ejection fractions) or eccentric (associated with abnormal responses to exercise). Recent data indicate that echocardiographic detection of LVH identifies mildly hypertensive patients at significant risk, a finding that may aid identification of patients for drug treatment.