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Hypertension is the major cause of left ventricular hypertrophy. While the electrocardiogram is an extremely insensitive measure of anatomic left ven- tricular hypertrophy, it provides a time-tested important marker of an adverse cardiovascular outcome. There has been a recent temporal decrease in the incidence of electrocardiographic evidence of L VH even within the hyperten- sive population; no doubt this is the result of large antihypertensive treatment experts. Anatomical evidence of left ventricular hypertrophy is best docu- mented pre-morbidly using echocardiographic techniques. It...

MICHEL E. SAFAR and MICHAEL F. O'ROURKE One of the principal problems of hypertension is the precise definition of blood pressure as a cardiovascular risk factor. Clinicians indicate peak systolic pressure and end diastolic pressure in the brachial artery as the principal criteria for blood pressure measurement. Consequently, these values are as indicators for clinical management and therapeutic adjustment. This used methodology, based on indirect blood pressure measurements at the site of the brachial artery relates only to the highest and lowest pressure in that vessel, and does not give...

The hemodynamic mechanisms of hypertension are often limited to the study of three dominant parameters: blood pressure, cardiac output and vascular resis- tance. Accordingly, the development of hypertension is usually analyzed in terms of a 'struggle' between cardiac output and vascular resistance, resulting in the classical pattern of normal cardiac output and increased vascular resistance, thus indicating a reduction in the caliber of small arteries. However, during the past years, the clinical management of hypertension has largely modified these simple views. While an adequate control of...