1. ABSTRACT
Introduction: Uncontrolled hypertension increases the total peripheral vascular resistance
considered as a silent vascular disease, with metabolic disorders, affecting different organs,
inducing pathological changes. Among them, heart damage, progressing from left ventricular
hypertrophy to heart failure by altering the left ventricular ejection fraction.
Objective: To determine the prevalence of left ventricular hypertrophy and left ventricular
ejection fraction by echocardiography in hypertensive patients in the area of Silver Spring, MD
and Washington DC.
Patients and methods: The study was descriptive, retrospective, transversal, and observational
variables control, in patients requested echocardiography studies (n = 218) during the established
period, 78.4% Latin American, 44% male. It was observed in the database of the Integrated
Prevention Unit.
Results: It was presented 41.4% of left ventricular hypertrophy among hypertensive. Among the
hypertensive patients of 70 years (94%) it was found 46.80% of left ventricular hypertrophy, all
of 70 years without hypertension, did not present left ventricular hypertrophy, there was
prevalence of hypertension and left ventricular hypertrophy in the older women. The left
ventricular ejection fraction of hypertensive patients was 97.6% normal, 1.6% slightly, 0.0%
moderate and 0.8% severe.
Conclusions: The prevalence of left ventricular hypertrophy in hypertensive patients was 41.4%,
and normal left ventricular ejection fraction is prevalent in the elderly without hypertension.
Keywords: Hypertension - Left Ventricular Hypertrophy - Ejection Fraction -
Echocardiography.

2. INTRODUCTION
High blood pressure, known as the silent disease, is probably the most important public issue in
developed countries, is common, asymptomatic and easily treated, but with lethal complications
if not treated.1 Over 74 million Americans suffer from hypertension and at least 16 million of
them do not even know. If we combine the data from developed and developing countries the
high blood pressure (HTN) affects 25-35% of the adult population. This figure increases to 60-
70% in those over 70 years.2, 3 The Framingham Heart Study revealed a significant increase in
the prevalence of left ventricular hypertrophy (LVH) in elderly patients with hypertension
(HTN).4
Systemic HTN is defined as the increase in pressures on the arterial walls by blood flow. In case
of pathological situations where there is increased afterload, the heart undergoes LVH to reduce
tension in the walls under the law of Laplace.5, 6
Echocardiography has been the standard procedure for calculating LVH more than 25 years, 13
provides information on the morphology, ventricular cavity, ventricular thickness, left
ventricular ejection fraction (LVEF), contraction of different segments and, as consequence of
this, of the global systolic function, an important factor in morbidity and mortality in
hypertension patients. Clinical and epidemiological studies demonstrate the diagnostic and
prognostic utility of echocardiography in hypertension, especially in the impact of LVH and
LVEF detected by echocardiography.1, 7 The LVH determined mainly by the increased size of
myocyte is the most common heart disease in hypertensive patients, and increases the risk of
premature cardiovascular events or death.8, 15
LVH is an important prognostic marker, and
monitoring a hypertensive patient should be followed with the study ecocardiográfico.18

3. General Objective
Determine the prevalence of LVH by echocardiography in hypertensive patients in the area of
Silver Spring, MD and Washington DC.
End Points
 Observe the prevalence of LVH in hypertensive patients between 70 years or older and
younger men and women.
 Compare the value of LVEF in hypertensive patients in relation to non-hypertensive
patients assessed by echocardiogram during the study period.

4. MATERIAL PATIENTS AND METHODS
Scope, duration of the study
The study was conducted over a period of seven months, from July 2010 until January 2011, in
the Francisco A. Matheus Clinic in Silver Spring, MD.
Methodological Design
The study was descriptive, retrospective, cross-temporal, and with control of observational
variables.
Study Population
The study samples were all hypertensive and non-hypertensive patients with echocardiography
study done. The inclusion criterion of the group was the medical study diagnostic
echocardiography of LVH and to have hypertension. Patients who did not wish to participate of
the study were excluded.
Sample Identification
The universe consisted of two hundred and eighteen (n = 218) echocardiography studies of sexes,
78.4% Latin American and 44% male.
Operationalization of variables
It was recorded in a Microsoft Access table the patients who were studied with
echocardiography, hypertensive patients were determined by mercury sphygmomanometer,

5. verified at the time they were in the clinic for consultation and the register of medical records.
LVH it was based on male values and cardiac ultrasound criteria was based on the methods of
the American Society of echocardiogram.16
The LVEF has a normal value greater than 50%, mild between 45% - 54%, moderate 30% - 44%
or severe less than 30% and the study was based on values masculino.15, 16
The (Compare Guide Line) current classification of arterial pressure determines the stage of the
condition the patient's blood pressure and the values used in this study were the level of blood
pressure (mmHg) Category Systolic Diastolic Normal <120 and <80. Pre-hypertension 120-139
or 80-89. Hypertension Stage 1: 140-159 or 90-99. Stage 2: 160 or 100.19
Instruments and data collection
The data were obtained with echocardiography study on the M-mode of the ultrasound
equipment Esaote Biosound model. The image of innovation; System type: MyLab 30CV; Serial
number: 01812. Medical records of patients who had attended the clinic during the months
indicated were also evaluated.
Statistical procedures
The following data were analyzed. In medical records: blood pressure, age, sex. The results of
cardiac ultrasound studies in patients request of echocardiography.
Ethical Aspects
All the recollected information of the study was authorized by the patients with an informed
consent and by the administrative department of the clinic.

6. RESULTS
Of all patients studied (n=218), 58.71% (n=128) had high blood pressure( ), among hypertensive
patients found, 41.4% (n=53) demonstrated LVH, as shown in Figure 1.
Among patients of 70 years or older 2.29% (n = 50) it was found 94% (n = 47) with hypertension
and among hypertensive patients founded it was recorded 46.80% (n = 22) of LVH. Among
female patients of 70 years or older 15.59% (n = 34), all of them had high blood pressure 100%
(n = 34) and among the hypertensive 47.05% (n = 16) demonstrated LVH.
The males aged 70 and older 7.33% (n = 16), 81.25% (n = 13) presented HTN and among those
with HTN, 46.15% (n = 6) demonstrated LVH. The number of patients can be seeing, based on
the total universe in Graphic 1.
Among patients of 69 years or less 77.06% (n = 168), it was found 48.21% (n = 81) of HTN and
among those patients hypertensive, 56.79% (n = 46) demonstrated LVH. Among female patients
of 69 years or less it was presented 26.78% (n = 45) of HTN and among hypertensive female
patients 69 years or less it was recorded 40% (n = 18) of LVH, Graphic 2.
Of men of 69 years or less it was presented 21.42% (n = 36) of HTN and among hypertensive
men of 69 years or less there was 77.77% (n = 28) of LVH, as shown in Graphic 2.
The patients with HTN presented LVEF of normal 97.6%, mild 1.6%, moderate 0.0% and severe
0.8% in the period, based on male values, as shown in Graphic 3.

7. DISCUSSION
The prevalence of LVH in patients with HTN found in this study (41.4%) is higher compared
with the results present in the Spanish journal of cardiology, showed 20.3%, 20 but the prevalence
of LVH presented in the Spanish journal of cardiology was taken by the electrocardiogram, as
compared with the results of Journal of the American Heart Association, 14.6% findings of LVH
in hypertensive patients, 21 the results of this study are still prominent.
In the town of Silver Spring, MD and D.C. is the prevalence of LVH in hypertensive patients and
is consistent with the values of LVH according the work of Devereux, the same technique used
in M-mode ultrasound with values between 12-30% of LVH or up to 60% when compared
hypertensive population reference centers in the treatment of HTA.22
Among patients 70 years or older found 94% with HTN and among those 69 years or less the
value of HTN decreased nearly doubled to 48.21%. This tells us that the percentage of HTN
patients of 70 years or more it becomes almost double, making it equivalent to the Framingham
Heart Study revealed that the older the patient, the greater the risk of hypertensive patients
presenting HVI.4
Among patients 69 years or so shows that LVH is high compared to the number of hypertensive
patients in the group of greater than or equal to 70 years, what makes us think (changing), and
that as hypertension is a silent disease, 1 lot patients do not know the severity of the disease,
leaving a shortfall in the treatment of hypertension in the productive age male and female
professional.
The main limitation of this study is their cross-cutting, limited observational estimates of the
prevalence of LVH in hypertensive patients, whereas pre-treatment variations as BP in

8. hypertensive patients. The variability of myocardial damage increase or decrease is not set and
the LVEF was not considered in relation to medication use of patients studied.
The increased variability of blood pressure in elderly patients may be present for the decline in
baroreceptor reflex function associated with increased stiffness and decreased elasticity caused
by old age and HTN.
The study shows the prevalence of LVH present in patients with HTN and surprised with the
absence of LVH in all hypertensive patients 70 years or more (n = 3), confirming other studies
on the high prevalence of LVH in patients greater than or equal to 70 years, 3 and the relationship
with the existence of the HTA.5, 6
Among all hypertensive patients studied, LVEF is expressed normally, which tells us that the
relation of blood pressure is directly related to the contractility cardiaca.8
We conclude that people who suffer from HTN and LVH caused by their lack of control,
especially the group of patients of 69 years does not know their status and have access to
diagnostic tools for proper monitoring and medical treatment because no satisfactory
socioeconomic factors and education level are not limiting so that patients could get more
information about the disease they suffer.
It is recommended that local health professionals who insist on educating the population and put
emphasis on home monitoring of blood pressure, as in patients 69 years or less have high blood
pressure and 56.79% (n = 46) of LVH among this hypertensive patients, these data are
worrisome because if compared between patients over 70 with younger patients, the prevalence
of LVH is more prominent among younger hypertensive patients.
It would help further studies for deeper correlation and pathogenesis of LVH associated with
blood pressure and LVEF to better prevent the consequence of the chronic development of

9. hypertensive cardiomyopathy, which is to be as devastating as the advanced stage other
complications of hypertension.
CONCLUSION
Among patients with HTN 58.71% (n = 128) there is a prevalence of LVH of 41.4% (n = 53).
The prevalence of LVH found in patients with HTN for men and women aged 70 or older
prevailed in female patients (47.05%) compared to male patients (46.15%).
Among patients of 70 years or older there are 94% with HTN and among those 69 years or less
the value of HTN goes under nearly the double to 48.21%.
The LVEF among hypertensive patient compared with non-hypertensive, there is a
predominance of abnormal LVEF among patients with hypertension compared to non-
hypertensive studied.

10. Figure 1: Comparison with hypertension and left ventricular hypertrophy.
Patients of 70 years or more
47
50
45
40 34
35
30
22
25
20 16
13
15
10 6
5
0
Male Female Total
Graphic 1: Patients presenting more risc of LVH, blue color: HTN, red color: LVH and HTN,
left axis: Number of patients.

11. Patients of 69 years or less
90 81
80
70
60
45 46
50
36
40 28
30 18
20
10
0
Male Female Total
Graphic 2: Patients presenting less risc of LVH, blue color: HTN, red color: LVH and HTN, left
axis: Number of patients.
Left Ventricular Ejection Fraction
100
100 97.6
90
80
70
60
50
40
30
20
10 0 0.8 0 0 0 1.6
0
Severe Moderate mild Normal
Graphic 3: Percentual of LVEF presented in HTN patients (red color) and non-HTN patients
(blue color) based on male values, left axis: Patients percentage (100%).

12. ACKNOWLEDGMENTS
Francisco A. Matheus, M.D., P.C., Gonzalo Alberto Rincón, M.D. and Theodros Dagnew, M.D.,
for them professional medical education and professional support of diagnostic imaging. My
acknowledgments to the Medical Center located at 13018 Georgia Ave Silver Spring, MD 20906
with their respective secretaries offices, Lizabeth Cardon De Pazos, Sandra Patricia Cea,
Gabriela Tirado and Elizabeth Cindy Climaco.

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