In an Afro-Caribbean population of 111 treated hypertensive patients, electrocardiographic left ventricular hypertrophy by any criterion was seen in 42% of patients and increased left ventricular mass index on echocardiogram was seen in 50% of patients. The sensitivity of various left ventricular scoring systems of the electrocardiogram for predicting increased left ventricular mass index was 3 to 31%, the specificity 80 to 96%. The echocardiogram may be the tool of choice for predicting cardiovascular risk in the hypertensive Afro-Caribbean patient.