Objective To explore the value of the combined application of R-wave amplitude index (RLI) +SV4 and Sokolow-Lyon voltage standard in optimizing the diagnostic sensitivity and specificity of left ventricular hypertrophy (LVH). Methods: 151 patients with essential hypertension who visited our hospital from January 2023 to December 2024 were selected as the research subjects. The patients were divided into the LVH group (58 cases) and the normal left ventricle group (93 cases) based on the left ventricular mass index (LVMI) in echocardiography. Both groups underwent electrocardiogram and echocardiography examinations.The echocardiographic parameters [systolic blood pressure, diastolic blood pressure, end-diastolic ventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular inner diameter (LVDd), left ventricular mass index (LVMI)] of the two groups were analyzed and compared; The electrocardiogram parameters (RLI, SV4 and Sokolow-Lyon voltages) of the two groups were analyzed and compared. The sensitivity, specificity and accuracy of the RLI + SV4 and Sokolow-Lyon standards and their combined examination were analyzed. The Kappa test was used to evaluate the consistency of each diagnostic criterion with "LVMI". Results: The systolic blood pressure, diastolic blood pressure, LVMI, IVST, LVPWT and LVDd in the LVH group were significantly higher than those in the normal group (P < 0.05). However, there was no significant difference in BSA between the two groups (P>0.05). The voltages of RLI, SV4 and Sokolow-Lyon in the LVH group were significantly higher than those in the normal group (P < 0.05). The diagnostic sensitivity (91.38%), specificity (92.47%), accuracy (92.05%) of the combined standard and the Kappa value with "LVMI" (0.783) were significantly higher than those detected by the RLI+SV4 and Sokolo-Lyon voltage standards alone (P < 0.05). Conclusion: The combination of RLI+SV4 and the Sokolow-Lyon voltage standard in the diagnosis of LVH has high sensitivity and specificity, and has high consistency with echocardiography.