Search

A group of 36 juvenile hypertensive patients underwent echocardiographic and electrocardiographic examinations. In 15 of them echocardiography detected increased left ventricular posterior wall and/or septal thickness in the diastole. Asymmetric septal hypertrophy with a septum posterior wall ratio greater than 1.3 was established in 7 cases (19%). The ECG abnormalities included signs of left atrial abnormality and voltage criteria after Sokolow-Lyon and McPhie. The sensitivity of electrocardiography in detecting left ventricular hypertrophy determined by echocardiography was 15% after Sokolow-Lyon, 15% after McPhie ad 31% using all the criteria combined. The specificity of ECG was 100, 87 and 87%, respectively. The ECG is less sensitive in left ventricular hypertrophy in younger individuals than in the adult population. This seems to be due to a lower degree of hypertrophy in the early stages of essential hypertension. No significant correlation of echocardiographically determined left ventricular mass with precordial ECG voltage was found.

We studied with M-mode echocardiography the morphology and function of the left ventricle in a group of 36 juvenile hypertensives with borderline hypertension, whose cuff arm pressure exceeded 150/90 mmHg in at least three separate sessions. The results were compared with those of 23 age-matched normotensives with no evidence of any cardiovascular disease. Left ventricular hypertrophy (i.e. septum and/or posterior wall thicknesses in diastole greater than or equal to 12 mm) was present in 13 subjects of the hypertensive group (36%). Significant increase of interventricular septal thickness together with higher septum/posterior wall ratio and a higher incidence of asymmetric septal hypertrophy were the most characteristic findings in juvenile hypertensives. Of the functional parameters the only observed difference between the two groups was an elevated peak velocity of left ventricular contraction in hypertensives which tended to correlate inversely with the values of septum/posterior wall ratio. Additional comparison of electrocardiographic and echocardiographic detection of left ventricular hypertrophy in young hypertensives revealed a lower sensitivity but a satisfactory specificity of electrocardiography (31 and 87% respectively). The results indicate that besides an elevated systemic arterial pressure, other factors such as increased sympathetic or humoral activity may play a role in the incipient stage of essential hypertension and that isolated septal hypertrophy seems to be an early sign of cardiac involvement.