The clinical differentiation of hypertensive heart disease from hypertrophic cardiomyopathy usually presents no problem but it is less clear whether an echocardiographic distinction can always be made and, if so, what those echocardiographic criteria of difference are. It can be inferred from recent publications that when echocardiographic criteria for hypertrophic cardiomyopathy are met in hypertensive subjects, both diagnoses may be made. This may be unjustified, and in order to clarify this problem that M-mode echocardiographic features of 37 patients with severe systemic hypertension were compared with those of 70 patients with hypertrophoic cardiomyopathy and normal blood pressure. Systolic anterior movement of the mitral valve and/or mid-systolic closure of the aortic valve were found in 82 per cent of patients with obstructive and 35 per cent of patients with non-obstructive hypertrophic cardiomyopathy. These features were not seen in patients with hypertension. The conventional echocardiographic features of left ventricular hypertrophy and function did not permit distinction between hypertensive heart disease and hypertrophic cardiomyopathy. The echocardiographic diagnosis of hypertensive heart disease from hypertrophic cardiomyopathy is, therefore, difficult unless systolic anterior movement of the mitral valve and/or mid-systolic closure of the aortic valve can be shown.
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