ABSTRACT: BACKGROUND: Left ventricular hypertrophy is a significant risk factor for cardiovascular complications such as ischemic heart disease, heart failure, sudden death, atrial fibrillation, and stroke. A proper non-expensive tool is required for detection of this pathology. Different electrocardiographic (ECG) criteria were investigated; however, the results were conflicting regarding the accuracy of these criteria. OBJECTIVE: To assess the accuracy of three electrocardiographic criteria in diagnosis of left ventricular hypertrophy in adult patients with hypertension using echocardiography as a reference test. PATIENTS AND METHODS: This is a hospital-based cross sectional observational study which included 340 adult patients with a history of hypertension (240 patients with left ventricular hypertrophy and 100 patients without depending on Echocardiographic results). Three electrocardiographic criteria including Sokolow Lyon Voltage, Cornell voltage, and Cornell voltage duration were evaluated for their sensitivity and specificity in detection of left ventricular hypertrophy in those patients. RESULTS: Each of older ages (over 50 years) (OR= (OR=6.25, 95%CI=3.75-10.39, p<0.001), male gender (OR=0.58, 95% CI= 0.36-0.93, p= 0.018) and type 2 diabetes mellitus (OR=8.14, 95%CI= 4.04-16.41, p<0.001) were significantly associated with development of left ventricular hypertrophy in patients with hypertension. The sensitivity and specificity of Sokolow Lyon Voltage, Cornell voltage, and Cornell voltage duration were 17.5% and 96%; 13.33% and 97%; and 10% and 98%, respectively. CONCLUSION: Older ages, male gender, and type 2 diabetes mellitus can increase the risk of left ventricular hypertrophy in hypertensive patients. All the studied criteria have low sensitivity and high specificity in recognition of the left ventricular hypertrophy in patients with hypertension, with no advantage of definite criterion over the others.