Ischaemia and left ventricular hypertrophy.

Left ventricular hypertrophy (LVH), diagnosed by ECG and echocardiography, is commonly associated with coronary heart disease. Hypertensive patients with LVH and myocardial ischaemia may be at particular risk. The prevalence of ischaemia in hypertensive LVH was addressed in THAMES (Tenormin in Hypertension and Myocardial Ischaemia Epidemiological Survey), which comprised 205 men with hypertension. Echocardiography revealed LVH (defined as a left ventricular mass index > or = 130 g m-2) in 140 patients (68%). Of these patients with LVH, myocardial ischaemia was diagnosed on exercise ECG testing in 24%, and by thallium scintigraphy in 14%. Although not proven, a logical approach would be to improve the prognosis by reversing LVH and reducing ischaemia. A recent meta-analysis has indicated that angiotensin-converting enzyme (ACE) inhibitors are the most effective drugs in reversing LVH. But beta-blockers may still be a logical first choice of drug, because of their valuable anti-ischaemic properties.