# 1 cause of LVH

For 2 years, my wife ( 51 yrs. - non smoking, normal weight, diet and good excersize habits ) has seen her hypertension levels increase to recently critical levels. Primary doctor's only treatment was to alter medications and dosages within the medication cocktail. March 06' she had a echocardiogram which showed all heart functions normal and no LVH was observed. Since then up to last month, blood pressure readings elevated in the 180/100 range & spiked in the 210+/100+ range which led to two ER visits for treatment. From a recent 2nd echocardiogram, LVH along with LV diastolic dysfunction and tricuspid regurgitation has been diagnosed. A nephrologist within 7 days brought her hypetension to 120/80 range and has been holding for 3 weeks. A ton of web research on this reveals across the board that the #1 cause of LVH and connected conditions are caused by uncontrolled - prolonged high levels of hypertension. Such sources are medical journels such as the mayo clinic and JAMA so no scare tactics are intended rather a set of medical conclusions from research and history. Much of the research also points out that LVH should be viewed as a residual potential condition that can develop from prolonged uncontrolled hypertension and that LVH and tricuspid issues may have to be corrected surgically if advanced enough. When is it felt that the treating physician should refer the patient to a neprhologist or cardiac specialist when reaching a point in time where uncontrollable status is rendered?

[Cleveland Clinic]

It depends on the physician, but if it were me treating your wife and noticed that I did not make any headway with my most aggressive regimen I would send her to a specialist.  Of course, in the field of HTN, as a cardiologist, I am a specialist.  A though workup is indicated at that point and ultimately, regardless of the condition, in most instances, BP can be treated with medications and close follow up.