How to Identify Hypertensive Patients at High Cardiovascular Risk? The Role of Echocardiography
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REVIEW ARTICLE
How to Identify Hypertensive Patients at High Cardiovascular Risk? The Role of Echocardiography Cesare Cuspidi • Marijana Tadic • Carla Sala Guido Grassi
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Received: 7 January 2015 / Accepted: 10 February 2015 Ó Springer International Publishing Switzerland 2015
Abstract Scientific authorities recommend that patients with arterial hypertension should be managed not only on the basis of blood pressure (BP) levels, but also on the assemement of total cardiovascular risk. In particular, evaluation of target organ damage (TOD) is of major relevance for identifying hypertensive individuals at high cardiovascular risk independently of clinic BP levels. Evidence of cardiac and extra-cardiac TOD has been consistently associated with worse cardiovascular prognosis. Unfortunately, detection of TOD markedly depends on sensitivity of diagnostic tools, at difference from evaluation of risk factors and associated diseases, usually reliably provided by accurate clinical examination and routine investigation. The purpose of this paper was to provide an updated, comprehensive review on the role of echocardiography in identifying hypertensive patients apparently uncomplicated, but exposed to a high cardiovascular risk
C. Cuspidi G. Grassi Department of Health Science, University of Milano-Bicocca, Milan, Italy C. Cuspidi (&) Istituto Auxologico Italiano, Clinical Research Unit, Viale della Resistenza 23, 20036 Meda, Italy e-mail: [email protected] M. Tadic University Clinical Hospital Centre ‘‘Dragisa Misovic’’, Belgrade, Serbia C. Sala Department of Clinical Sciences and Community Health, University of Milano and Fondazione Policlinico di Milan, Milan, Italy G. Grassi IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
due to the presence of subclinical structural and functional cardiac alterations of adverse prognostic significance. Keywords Hypertension High cardiovascular risk Echocardiography
1 Introduction Since the end of the 1990s, major international guidelines of hypertension management (the 1999 and 2003 WHO/ International Society of Hypertension Guidelines and the 2003, 2007 and 2013 ESH/ESC Guidelines) have been recommending that management of hypertensive patients should be based not only on blood pressure (BP) levels, but also on the assessment of total (or global) cardiovascular risk [1–5]. These recommendations have been supported by available evidence that only a limited fraction of the hypertensive population is affected by BP elevation alone, a major fraction presenting additional non-modifiable and modifiable cardiovascular risk factors. Recent 2013 ESH/ESC Guidelines recommend a simple flow-chart for estimating the combined effect of risk factors, target organ damage (TOD) and comorbidities on global risk of fatal cardiovascular events [5]. Estimates take into account systolic and/or diastolic BP levels, coexistence of modifiable (smoking, dyslipidaemia, glucose intolerance, obesity) and non-modifiable (male sex, age and family history of premature cardiovascular disease) risk
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