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Left ventricular hypertrophy (LVH) is an independent cardiovascular risk predictor. A small amount of treated hypertensive (HBP) patients (p) develope new (n) LVH which could affect adversely the prognosis. The aim of this study is to determine the variables associated to n LVH development in treated HBP p.Consecutive HBP p on stable treatment at least 4 weeks without (w) LVH. Follow up for at least one year. Left ventricular mass index (LVMI) was measured by Devereux method at baseline and at follow up. LVH was considered > 95 g/m2 in women and > 115 g/m2 in men. Sixty demographic, anthropometric, cardiovascular risk factors, 2-D ultrasonographic, tissue Doppler, central aorta and peripheral hemodynamics, ABPM, laboratory and treatment variables were included in the algorithm. STATISTICAL ANALYSIS: Students t test, odds ratio, multivariate analysis; p < 0.05 considered statistically significant.145 treated HBP p included, follow up 593+-264 days. Sample mean age was 56.7+-10.9 years, 78 p (53.8%) were males. 22 p (15.2%) developed n LVH. Baseline LVMI was 85+-17.4 g/m2 in n LVH p and 81.2+-15.8 g/m2 in w LVH p; follow up LVMI was 108.4+-15.3 g/m2 in n LVH p and 79.7+-16.9 g/m2 in w LVH p (p < 0.0005). 14 p (63.6%) increase 1 SD and 6 p (27.3%) 2 SD LVMI in n LVH p while 18 p (12.4%) increase 1 SD and 2 p (1.4%) 2 SD LVMI in w LVH p (p < 0.0005). Female sex (OR 2.52; 95 % CI 1.02–6.27; p < 0.025) and abnormal transmitral Doppler E/A ratio (OR 2.52; 95 % CI 1.09–6.96; p < 0.025) were the only predictors of n LVH. Cardiovascular risk < 10% by Framingham score had OR 0.48; CI 0.19–1.18; p = NS.1) One over six treated HBP p developed n LVH; 2) Female and abnormal transmitral Doppler E/A ratio are predictors of n LVH.