The presence of Left Ventricular Hypertrophy (LVH) in a patient with systemic hypertension deserves serious attention and makes its clinical diagnosis a priority. Over the years various criteria have been proposed for the electrographic (ECG) diagnosis of LVH and the sensitivity and specificity of these criteria have been extensively studied in Caucasians. Recent evidence indicates that they are inapplicable to people of African descent. Unlike echocardiography (ECHO), the ECG is generally available, cheap but has a lower sensitivity in detecting LVH compared to echocardiography. This study was conducted to evaluate ECG criteria against 2-dimensional (2-D) guided M-mode echocardiography in the diagnosis of LVH in adult Gambians. Secondly, to determine the ECG criteria using the Minnesota, Araoye, Sokolow and Lyon or Wolff criteria with the overall best accuracy for the diagnosis of LVH. Two hundred and eight (208) consecutive patients with systemic hypertension (BP ≥140/90mmHg) with or without treatment and an age matched group of 108 non-hypertensive patients were enrolled from outpatient clinics. A questionnaire was filled. All patients were investigated with 2-D guided M-mode echocardiography and a standard 12-1ead ECG. Anthropometric measurements were also taken. The gold standard was the Penn formula to determine the left ventricular mass index (of 125 g/m 2 in males and 110 g/m 2 in females as the cutoff for LVH). Using this gold standard the prevalence of echocardiographic LVH was 47.5% and 27.8 % in the hypertensives and non-hypertensives respectively (P<0.01). By the Receiver Operating Characteristic (ROC) Curves Sokolow and Lyon was nearest to the top left-hand corner in the hypertensives with a distance of 6.6 cm. But in the non-hypertensives Wolff was nearest to the top left-hand corner with a distance of 8.5 cm. There was correlation between the Minnesota, Araoye, Sokolow and Lyon and Wolff ECG criteria and echocardiographic left ventricular mass index in the hypertensives (Spearman rho = 0.25-0.34, P < 0.01) but in the non-hypertensives there was no correlation (P > 0.05). Sokolow and Lyon criterion had overall best accuracy for the electrocardiographic diagnosis of left ventricular hypertrophy in hypertensives and is further recommended for use as such. But for non-hypertensives, the Wolff criterion had overall best accuracy.