QTc dispersion and Cornell duration product can predict 10‐year outcomes in hypertensive patients with left ventricular hypertrophy

Background

Persistent and adequate treatment of patients with arterial hypertension leads to more favorable disease outcome.

Hypothesis

Aside for the present left ventricular hypertrophy (LVH), there are other non‐invasive parameters which can represent additional predictors of unfavorable prognosis in patients with essential arterial hypertension during the 10‐year follow‐up.

Methods

A hypertensive group with LVH (124 patients; age 57.0 ± 8.0; 84 males and 40 females) was included in the study and examined noninvasively. Patients used regular medication therapy during the follow‐up period.

Results

During the 10‐year follow‐up period, unfavorable outcome was recorded for 40 (32.3%) patients. Patients with unfavorable outcome had higher baseline values of left ventricular mass index (178.9 ± 29.5 g/m² vs 165.5 ± 29.5 g/m²; P < 0.05) and QTc dispersion (64.1 ± 24.7 ms vs 54.8 ± 19.4 ms; P < 0.05). Frequency of positive Cornell product was higher in the group of patients with unfavorable outcome (35% vs 22.2%; P < 0.01). Positive Lyon‐Sokolow score did not show statistical significance (25% vs 11.9%; P = 0.06). Cornell product (β = 0.234; P < 0.01) and QTc dispersion >65 ms (β = 0.184; P < 0.05) had prognostic significance in LVH (multiple regression analysis: R = 0.314, R = 0.099, adjusted R = 0.084, standard error of the estimate = 0.449, P < 0.05).

Conclusions

Patients with a positive Cornell product and larger QTc dispersion had more unfavorable 10‐year outcomes compared with other patients with LVH.

     

Echocardiographic left ventricular geometry in hypertensive patients with electrocardiographic left ventricular hypertrophy: The LIFE Study

Aim: To assess the prevalence of echocardiographic left ventricular hypertrophy (LVH) and concentric remodeling in hypertensive patients with electrocardiographic (ECG)-LVH and to estimate the costeffectiveness of echocardiography and ECG for detection of LVH.Design: Echocardiographic LV measurements and the prevalence of abnormal LV geometric patterns were compared between 964 hypertensive patients with ECG-LVH (Cornell voltage-duration product > 2440 and/or SV₁     

氯沙坦对高血压左室肥厚患者血浆脑钠肽的影响

目的：研究氯沙坦干预对高血压伴左室肥厚患者脑钠肽（BNP）的影响及意义。方法：选择100例左室射血分数正常范围的高血压患者,其中58例伴左室肥厚,42例不伴左室肥厚,另选50例健康者作为健康对照组,比较三组间血浆BNP水平。左室肥厚组给予氯沙坦治疗6个月,比较治疗前后BNP、左室质量指数（LVMI）的变化。结果：①高血压伴左室肥厚患者BNP浓度显著高于不伴左室肥厚组及健康对照组[（62．21±9．70）pg／ml比（39．35±10．57）pg／ml比（13．89±5．34）pg／ml,P〈0．01];②BNP的浓度与LVMI呈正相关（r=0．44,P〈0．05）;③与治疗前比较,氯沙坦治疗高血压伴左室肥厚6个月后,血浆BNP[（62．21±9．70）pg／ml比（38．78±7．94）pg／m1]、LVMI[（128．71±12．64）g／m。比（107．36±11．32）g／m。]均显著降低（P〈o．01）。结论：氯沙坦可明显降低高血压伴左室肥厚患者脑钠肽水平,逆转左室肥厚。     

高血压左室肥厚与脑卒中的相关性分析

目的：探讨高血压病引起的左心室肥厚、左心室重量增加对房室传导、心肌细胞复极离散度及脑卒中的影响。方法：临床确诊的高血压病人188例，采用超声心动图测量室间隔厚度及左心室重量，心电图测量P—Rd、Q—Td、J—Td。结果：合并左室肥厚者108例，不合并左室肥厚者80例。左室肥厚组患者P—Rd、Q—Td、J—Td及脑卒中发生率明显高于不合并左室肥厚者。结论：高血压左室肥厚与房室传导时限、心室肌复极的一致性及脑卒中发生率密切相关，可能成为预测脑卒中发生的危险因素之一。     

Thresholds in the relationship between mortality and left ventricular hypertrophy defined by electrocardiography

Background

Electrocardiographic criteria for the diagnosis of left ventricular hypertrophy in current use were defined using autopsy results or echocardiography; criteria defined using mortality might be more clinically meaningful.

Methods

Using data from Third National Health and Nutrition Examination Survey (NHANES III), we selected electrocardiographic measures that best differentiated those surviving at 5 years from those who did not. We identified voltage thresholds using regression techniques and then compared survival for subjects above and below the thresholds.

Results

Cornell voltage, Cornell product, and Novacode estimate of left ventricular mass index were discriminative for mortality and had identifiable thresholds present in their relationships with mortality. Independent of systolic blood pressure, there were significant associations with 5-year mortality for Novacode index above threshold; hazard ratios were 1.58 for women and 1.27 for men, and for 5-year cardiovascular mortality were 1.78 for women and 2.34 for men.

Conclusions

Electrocardiographic criteria for left ventricular hypertrophy validated against mortality might be clinically useful.     

高血压左心室肥厚患者心电图QT离散度改变

目的　探讨原发性高血压左心室肥厚患者心电图QT离散度 (简称QTd)变化。　方法　用美国超九 ATL(XO16 3)彩色多谱勒诊断仪二维超声测量其舒张期左心室室间隔厚度和左心室后壁厚度 ,以≥ 1 2cm作为左心室肥厚诊断标准 ,对高血压左心室肥厚组 (n =36 ,男 女 =2 0 16例 ,平均年龄 6 0岁± 12岁 )、高血压左心室非肥厚组(n =5 0 ,男 女 =30 2 0例 ,平均年龄 6 2岁± 12岁 )进行测量 ,再用心电图ECG 8110P( 0 180 8A3)描记其常规 12导联心电图 ,手工测量其最大QT间期 (QTmax)、最小QT间期 (QTmin)和心动周期RR间期 ,计算QTd和心率校正的QTcd ,并随机匹配正常人群组 (n =4 0 ,男 女 =2 4 16例 ,平均年龄 5 8岁± 13岁 )。　结果　高血压左心室肥厚组QTd为6 0ms± 17ms ,QTcd为 6 8ms± 2 4ms,高血压左心室非肥厚组QTd为 4 1ms± 13ms,QTcd为 4 3ms± 17ms ,正常人群组QTd为 4 3ms± 11ms ,QTcd为 4 4ms± 16ms,前两组比较有显著性差异 ,P <0 0 1,后两组比较无显著性差异 ,P >0 0 5。　结论　原发性高血压左心室肥厚患者QT间期离散度增大。     

Serial evaluation of electrocardiographic left ventricular hypertrophy for prediction of risk in hypertensive patients

Background

Although the presence and severity of electrocardiographic (ECG) left ventricular hypertrophy (LVH) have been associated with an increased risk of cardiovascular (CV) morbidity and mortality, the relationship of regression of ECG LVH during antihypertensive therapy to CV risk has only recently been examined.

Methods

Electrocardiographic LVH was evaluated over time in 9193 hypertensive patients enrolled in the Losartan Intervention for Endpoint Reduction in Hypertension study. Patients were treated with losartan- or atenolol-based regimens and followed with serial ECGs at 6 months and then yearly until death or study end. Electrocardiographic LVH was measured using gender-adjusted Cornell product (RaVL + SV3 [+6 mm in women]) ? QRS duration) and Sokolow-Lyon voltage (SV1 + RV5/6).

Results

After mean (SD) follow-up of 4.8 (0.9) years, the Losartan Intervention for Endpoint Reduction in Hypertension study composite end point of CV death, nonfatal myocardial infarction, or stroke occurred in 1096 patients. In Cox regression models controlling for treatment type, baseline Framingham risk score, baseline, and in-treatment blood pressure and for severity of baseline ECG LVH by Cornell product and Sokolow-Lyon voltage, lower in-treatment ECG LVH by Cornell product and Sokolow-Lyon voltage were associated with 14% and 17% lower rates, respectively, of the composite CV end point: adjusted hazard ratios (HRs) of 0.86 (95% confidence interval [CI], 0.82-0.90; P < .001) for every 1050 mm · ms (1 SD) decrease in Cornell product and 0.83 (95% CI, 0.78-0.88; P < .001) for every 10.5 mm (1 SD) decrease in Sokolow-Lyon voltage. In parallel analyses, lower Cornell product and Sokolow- Lyon voltage were each independently associated with lower risks of CV mortality (HR, 0.78; 95% CI, 0.73-0.83; P < .001; HR, 0.80; 95% CI, 0.73-0.87; P < .001), of myocardial infarction (HR, 0.90; 95% CI, 0.82-0.98; P = .011; HR, 0.90; 95% CI, 0.81-1.00; P = .043), and of stroke (HR, 0.90; 95% CI, 0.84-0.96; P = .002; HR, 0.81; 95% CI, 0.75-0.89; P < .001). Regression of ECG LVH was also associated with significantly reduced risks of sudden cardiac death, new-onset atrial fibrillation, hospitalization for heart failure, and new-onset diabetes mellitus.

Conclusions

Regression of ECG LVH by Cornell product and/or Sokolow-Lyon voltage criteria during antihypertensive therapy is associated with lower likelihoods of CV morbidity and mortality, all-cause mortality, and new-onset diabetes, independent of blood pressure lowering and treatment modality in essential hypertension. These findings suggest that antihypertensive therapy targeted at regression or prevention of ECG LVH may improve prognosis.     

V_1、V_2、V_3的S波及Ⅰ、Ⅱ、aVL的R波之和在诊断左室肥大中的价值

目的探讨诊断左室肥大(LVH)新的心电图指标。方法以超声心动图测定的左室重量(LVM)及重量指数(LVMI)为对照,其诊断LVH的标准为>125g/m2(男),120g/m2(女),对100例正常健康人及111例患者进行了观察,对12导联QRS总振幅(∑QRS)、V1～V3导联的S波之和(∑SV1～V3)、Ⅰ、Ⅱ、aVL导联的R波之和(∑RⅠ、Ⅱ、aVL)及后两者之和(Z表示),分别进行了测定。寻找新指标的正常值范围以及以此标准为依据,诊断LVH的灵敏度、特异度、准确率。结果正常组中,∑QRS、∑SV1～V3、∑RⅠ、Ⅱ、aVL及Z值正常范围分别为77～175,11～38,5～23及22～54mm,以大于这些指标的正常值上限为标准,其诊断LVH灵敏度、特异度及准确率较传统指标明显提高,其中Z值>54mm灵敏度最高(86.54%),准确率最高(90.09%),而特异度仍保持在93.22%。结论LVH新的心电图指标具有一定诊断价值,其中Z>54mm最好。     

应用多普勒组织成像技术评价原发性高血压左室舒张功能及其相关因素

目的:应用多普勒组织成像技术(DTI)探讨原发性高血压(EH)左室舒张功能的特点,同时检测血中心钠素(ANP)、脑钠素(BNP)的变化,分析两者与左室舒张功能的关系。方法:对照组20例,EH患者(EH组)61例,均行常规超声及DTI检查,EH患者根据左室质量指数(LVMI)分为左室心肌肥厚(LVH)亚组和无 LVH(NLVH )亚组。DTI测量二尖瓣侧环心肌舒张早期峰值运动速度(e)、晚期峰值运动速度(a)及其比值(e/a),测量二尖瓣瓣尖水平舒张早期的最大流速(E0)、舒张晚期的最大流速(A)及 E0 与A流速的比值E0/A。入选病例均测定血浆ANP、BNP浓度。结果:与对照组相比,EH患者E0/A、e/a减小,LVH亚组减小更明显;与对照组相比,EH血浆 ANP、BNP浓度升高, LVH升高更明显; E0/A、e/a比值与 ANP 呈负相关( r = - 0.56和 r = -0.60, 均P<0.01),与BNP呈负相关( r=-0.62和 r=-0.65,均 P<0.01)。结论:血浆 ANP、BNP与应用DTI技术评价的EH左室舒张功能均有较好相关性。     

老年男性心电图Cornell电压标准及其应用价值

目的 探讨老年男性心电图Comell电压标准及其诊断老年男性左室肥厚的价值.方法 回顾性分析北京医院自1990年来进行尸体解剖的老年男性患者资料,排除心电图ORS波时限≥0.12 s及起搏心电图的患者.测量死亡前3个月内标准12导联心电图QRS波振幅,分析老年男性Comell、Sokolow-Lyon电压值与左室前壁厚度的相关性.计算老年男性无器质性心脏病组Comell电压值的均数及其97.5%的上限值,分析老年男性心电图Comell电压标准诊断老年男性左室肥厚的敏感性、准确性.结果 老年男性心电图Comell、Sokolow-Lyon电压值与左室前壁厚度相关.老年男性无器质性心脏病组心电图Sv3+RaVL平均值为(1.32±0.79)mV,以其97.5%的上限值2.9 mV为Comell标准诊断老年男性左室肥厚的敏感性、准确性分别为34.3%、77.5%,高于Sokolow-Lyon标准.结论 心电图Comell电压标准诊断中国老年男性左室肥厚的界值可采用2.9 mV,其诊断老年男性左室肥厚的敏感性、准确性高于Sokolow-Lyon标准.     

心肌组织多普勒成像技术评估左室肥厚对左室收缩运动协调性的影响

目的评价左室肥厚对左室收缩运动协调性和功能的影响。方法正常对照组18例(组1)、高血压性心脏病患者18例(组2)和肥厚型心肌病患者16例(组3)。应用组织多普勒成像技术测量左室收缩期电机械运动的时间离散度(DTQ-S)、室间隔和左室侧壁6个位点的心肌收缩期峰值速率(Vs)。结果与组1相比,组3DTQ-S延长(P<0.001),各位点Vs值降低(P<0.05);组2上述数值无明显变化。结论肥厚型心肌病存在左室运动收缩协调障碍和收缩功能下降。     

心电图诊断老年男性左心室肥厚的价值

目的 探讨心电图诊断老年男性左心室肥厚的价值.方法 回顾性分析我院自1990年进行尸体解剖的老年男性患者资料,排除心电图QRS波时限≥10.12 s及起搏心电图的患者,测量死亡前3个月内标准12导联心电图QRS波振幅,分析老年男性不同年龄组心电图QRS波振幅与左心室前壁厚度的相关性.结果 心电图V5、V6、I、aVL导联R波幅度[分别为(1.1±0.7)mV、(0.9±0.6)mV、(0.4±0.3)mV和(0.3±0.3)mV]及心电图左胸导联(V5或V6)R波幅度与右胸导联(V1)S波幅度之和[(1.9±1.2)mV)与左心室前壁厚度[(13.6±5.4)mm]具有相关性(相关系数分别为0.22、0.14、0.22、0.23、0.23;P均<0.05).心电图左胸导联(V5或V6)R波幅度与右胸导联(V1)S波幅度之和与左心室前壁厚度的相关性60～79岁组最强(相关系数为0.48,P<0.01),80～89岁组二者相关性减弱(相关系数为0.23,P<0.05),而90～101岁组二者无相关性(相关系数为0.03,P>0.05).结论 心电图左心室肥厚诊断标准在90岁以下老年男性中具有可靠性.     

高血压左室肥厚及心功能与血浆脑钠肽浓度变化的关系探讨

目的 探讨高血压患者左室肥厚及左室舒张功能与血浆脑钠肽（BNP）浓度的关系.方法 高血压患者62例,其中伴左心室肥厚组患者32例,不伴左心室肥厚组患者30例;健康对照组30名.高血压患者给予厄贝沙坦片75～150 mg/d,治疗6个月.所有对象行超声心动图测定左心室重量指数（LVMI）、E/A（二尖瓣舒张期E峰/A峰）比值.采用美国博适Triage及其试剂盒快速测定血浆BNP水平,对BNP与LVMI、E/A比值作相关分析.结果 高血压左心室肥厚患者组的血浆BNP水平（ng/L）明显高于高血压不伴左心室肥厚患者组和健康对照组（54.8±16.9比36.7±15.4,P＜0.05;54.8±16.9比16.4±12.7,P＜0.05）.经厄贝沙坦治疗后,高血压左心室肥厚患者组血浆BNP水平（ng/L）明显下降（54.8±16.9比36.8±12.6,P＜0.05）,E/A比值明显上升（0.86±0.57比1.09±0.65,P＜0.05）,差异有统计学意义,且与LVMI呈显著正相关 （r＝0.57,P＝0.028）,与E/A比值呈显著负相关（r＝-0.68,P＝0.009）.结论 血浆BNP浓度能较好地反映高血压患者左心室肥厚及左室舒张功能状态.     

高血压左室肥厚心电综合电压诊断价值分析

目的 探讨心电图综合电压标准在高血压左室肥厚（LVH）中的诊断价值,为高血压LVH的筛查、诊断和疗效观察提供依据.方法 按照美国超声学会（ASE）推荐使用的操作常规（ASE Convention）检测90例中国高血压LVH患者心脏质量指数（UCG-LVMI）,心电电压各参数反复测3个心动周期,取均值,评价心电图综合电压标准在高血压LVH中的诊断价值.结果 根据Cornell新标准,90例中国高血压LVH患者真阳性发生率为60.0%（男性）和64.4%（女性）,假阴性发生率为40.0%（男性）和35.6%（女性）.临床诊断评价：敏感度RⅠ＋SⅢ 20.0%、RV5＋SV1 36.7%、Ravl＋SV3 62.2%,特异度 RⅠ＋SⅢ 100%、RV5＋SV1 94.5%、Ravl＋SV3 95.5%,准确度RⅠ＋SⅢ 64.0%、RV5＋SV1 69.5%、Ravl＋SV3 82.0%.结论 ECG-Cornell标准诊断高血压LVH的敏感度、特异度和准确度分别为62.2%、95.5%和82.0%.综合电压中Cornell电压诊断的敏感度、特异度和准确度最高,是高血压LVH筛查、诊断、预后的理想指标.     

脑钠肽联合组织多普勒检查对老年高血压患者左室肥厚及舒张功能受损的评估

目的 探讨老年原发性高血压患者左室肥厚(LVH)及舒张功能与脑钠肽(BNP)水平的关系.方法 140例老年原发性高血压患者,其中左室肥厚(LVH)组69例,非左室肥厚(NLVH)组71例,健康对照组50例.测定各组BNP浓度.常规脉冲多普勒测量二尖瓣口舒张早期血流速度(E)、舒张晚期血流速度(A),计算E/A值.应用定量组织速度成像(QTVI)技术测量左室壁二尖瓣环6个位点(侧壁和后间隔、前壁和下壁、前间隔和后壁)处的舒张早期峰值运动速度(Em)、舒张晚期峰值运动速度(Am),计算Em/Am值,同时计算6个位点平均速度(MEm、MAm)、MEm/MAm值及E/MEm值.比较3组间舒张功能指标的变化,以及BNP浓度与超声指标的关系.结果 高血压NLVH组、LVH组E/MEm(11.3±1.83、15.7±1.45)及BNP浓度[(61.64±37.18)ng/L、(138.65±30.23)ng/L]较对照组升高(P＜0.05及P＜0.01);MEm[(6.32±0.94)cm/s、(4.29±0.91)cm/s]及MEm/MAm值(0.76±0.19、0.51±0.11)较对照组减低(P＜0.05及P＜0.01);高血压组BNP浓度与E/A、MEm、MEm/MAm值显著负相关(r=-0.294、r=-0.387、r=-0.422,均P＜0.01),与LVMI及E/MEm值显著正相关(r=0.342及r=0.501,均P＜0.01).结论 高血压患者无论有无左室肥厚均有舒张功能减低,而LVH患者左室舒张功能障碍更为严重.联合血浆BNP浓度和超声指标有助于准确评估老年高血压患者左室肥厚和舒张功能.

Abstract：

Objective To investigate the clinical values of brain natriuretic peptide (BNP) in combination with TDI in diagnosing left ventricular hypertrophy (LVH) and impaired diastolic function in elderly hypertensive patients. Methods The 140 elderly hypertensive patients were divided into LVH group (n=69) and NLVH group (n=71). Control group consisted of 50 normal subjects. Plasma BNP level and index of echocardiography, including mitral peak flow velocity during early and late diastole (E, A), ratio of E/A, average peak velocities of six LV wall sites at mitral annuluses during early and late diastole (MEm, MAm), ratios of MEm/MAm and E/MEm were measured in all patients. The correlation of plasma BNP level with cardiac ultrasonographic findings was also examined. Results The level of BNP [(61.64±37.18)ng/L, (138. 65±30. 23)ng/L] and the ratio of E/MEm (11.3±1.83, 15.7±1.45) were significantly higher in NLVH group and LVH group than in normal group (P＜0. 05 or P＜0. 01). MEm [(6.32±0. 94)cm/s, (4.29±0. 91)cm/s]and MEm/MAm (0.76±0.19, 0.51±0. 11) were significantly lower in NLVH and LVH group than in normal group (P＜0.05 or P＜0. 01). The BNP level was negatively correlated with E/A, MEm and MEm/MAm (r=- 0. 294, r= 0. 387 and r= 0. 422, all P＜0. 01), and was positively correlated with LVMI and E/MEm (r=0.342, r=0.501, all P＜0.01). Conclusions Left ventricular diastolic function is impaired in elderly hypertension patients regardless of LVH or NLVH.Plasma BNP level in combination with echocardiography parameter is accurate to evaluate the LVHand impaired diastolic function in elderly hypertensive patients.     

氯沙坦对高血压左室肥厚血清脑钠肽的影响

目的探讨氯沙坦对高血压左室肥厚(LVH)患者血清脑钠肽(BNP)水平的影响及其意义。方法选取高血压LVH患者44例,随机分为治疗组和对照组各22例,治疗组服用氯沙坦20周,对照组不给氯沙坦,治疗前后血清BNP浓度以电化学发光法测定,左室重量指数(LVM I)用超声心动图测定。结果高血压LVH患者氯沙坦治疗后LVM I和血清BNP水平分别从(151.54±33.01)g/m3与(174.30±146.95)ng/L降为(134.36±22.71)g/m3与(110.31±83.06)ng/L(P均<0.05),两者治疗前后均呈显著正相关,r分别为0.8和0.75(P均<0.001),血清BNP水平下降的患者LVM I从(147.16±32.97)g/m3降为(131.15±23.48)g/m3(P<0.01)。结论氯沙坦能逆转高血压LVH及降低血清BNP水平,BNP可能可作为高血压治疗后LVH是否逆转的参考指标之一。     

Evaluation of brain natriuretic peptide as marker of left ventricular dysfunction and hypertrophy in the population

OBJECTIVE: To evaluate brain natriuretic peptide (BNP) as marker of left ventricular (LV) dysfunction and hypertrophy in a population-based sample of 610 middle-aged subjects (50-67 years) who were further characterized with respect to hemodynamic and anthropometric parameters and by echocardiography. RESULTS: Left ventricular (LV) systolic function, LV mass-index, age, gender, heart rate, and medication with beta adrenergic receptor blockers were significant and independently correlated with BNP (multivariate analysis, P < 0.05 each). As compared to subjects with normal LV function and mass-index (control), subjects with LV dysfunction (LV fractional shortening < 28%) or hypertrophy (LV mass-index > 110 g/m2 in women and > 134 g/m2 in men) were characterized by increased BNP. The increase in BNP associated with LV hypertrophy (n = 69, +101% versus control, P < 0.0001) was similar in magnitude to that associated with LV dysfunction (n = 39, +98% versus control, P < 0.03). These increases were markedly exceeded in subjects with severe LV dysfunction (n = 11, LV fractional shortening < 22%, BNP +197% versus control, P < 0.01), particularly in the presence of concomitant hypertrophy (n = 7, +227%, P < 0.01). The predictive values of BNP varied considerably with the degree of LV dysfunction and the presence or absence of concomitant LV hypertrophy. With 0.81, the highest area under the receiver operator characteristic curve was obtained for the detection of severe LV dysfunction and concomitant hypertrophy and sensitivity, specificity, positive and negative predictive value for this condition were 71, 86, 7 and 99.5%, respectively, for a cut-off of 34 pg/ml. CONCLUSIONS: The current study provides new insight into regulation and diagnostic value of BNP in middle-aged subjects and demonstrates important independent effects of LV function and mass upon BNP plasma concentrations. Although measurement of BNP cannot be recommended for the detection of marginally impaired LV function in the population, it may be helpful to suggest or exclude severe LV dysfunction with concomitant hypertrophy.     

B-type natriuretic peptide and left ventricular hypertrophy in hypertensive patients.

AIM: To assess the accuracy of B-type natriuretic peptide (BNP) plasma levels for the diagnosis of left ventricular hypertrophy (LVH) in hypertensive patients. PARTICIPANTS AND METHODS: We studied a sample of 409 adults aged 45 years or older, recruited from residents of Porto by random digit dialing. Data were collected by clinical interview and physical examination, ECG, echocardiogram and venous blood sampling for the measurement of plasma concentrations of BNP. Hypertension (HT) was defined as blood pressure > or = 140/90 mmHg on the day of interview and/or self-reported HT if treated with any antihypertensive medication; LVH was defined as left ventricular mass index (LVMI) > or = 125 g/m2 in men and 110 g/m2 in women. The participants were further classified in four strata according to left ventricular morphology--normal, concentric remodeling, eccentric LVH or concentric LVH. RESULTS: Two hundred and thirty-two (56.7%) individuals were hypertensive, and among these 73 (31.5%) had LVH. BNP levels were significantly higher in these individuals (median [P25-P75] = 55.8 pg/ml [22.6-88.4]) than in hypertensive patients without LVH (29.9 pg/ml [10.0-62.8]), p = 0.003. BNP levels also differed significantly across strata of left ventricular geometry, the main difference depending on the presence or absence of LVH. There was a positive correlation between plasma BNP levels and LVMI (Spearman's P 0.185, p = 0.005). The area under the ROC curve--a parameter for diagnostic accuracy quantification--was 0.62 (95% confidence interval 0.54-0.70), indicating low discriminatory power between normal and abnormal LVMI. CONCLUSION: In the assessed population, BNP levels were higher in hypertensive patients with LVH than in the absence of LVH. However, BNP did not perform well in discriminating between the presence or absence of LVH.