Regression Under Treatment of Left Ventricular Hypertrophy and Other Structural Alterations
Hypertension-induced mortality and morbidity are produced through the impact of increased blood pressure (BP) on the heart and other target organs. Evaluation of early damage (TOD) in these target organs is an important step in a risk stratification strat
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Maria Lorenza Muiesan, Anna Paini, Fabio Bertacchini, Claudia Agabiti Rosei, and Massimo Salvetti
19.1 Introduction Hypertension-induced mortality and morbidity are produced through the impact of increased blood pressure (BP) on the heart and other target organs. Evaluation of early damage (TOD) in these target organs is an important step in a risk stratification strategy to reduce cardiovascular and renal events. The ESH-ESC Guidelines 2013 [1] encouraged the convenience of assessing target organ damage for global risk stratification and of repeating TOD assessment during the follow-up. Among a panel of TOD included in the 2013 guidelines and based on availability, cost, and clinical significance, the evaluation of left ventricular hypertrophy (LVH) by electrocardiography and, possibly, the assessment of left ventricular (LV) mass by echocardiography are among the minimal recommended, in addition to urinary albumin excretion and glomerular filtration rate. Maladaptation of the heart in response to chronic hypertension is often associated with deleterious disorders, including cardiac fibrosis, chronic inflammatory response, and cardiac dysfunction, leading to heart failure, which remains to be a leading cause of mortality and morbidity around the world. Several studies have shown that the regression of asymptomatic TOD occurring during treatment reflects the treatment-induced reduction of morbid and fatal CV events, thereby offering valuable information on whether patients are more or less effectively protected by the target BP achieved and the treatment strategies adopted. In the future precise targets to treat pathologic cardiac hypertrophy and heart failure more effectively are warranted.
M. L. Muiesan (*) · A. Paini · F. Bertacchini · C. A. Rosei · M. Salvetti Internal Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy e-mail: [email protected]; [email protected] © Springer Nature Switzerland AG 2019 M. Dorobantu et al. (eds.), Hypertension and Heart Failure, Updates in Hypertension and Cardiovascular Protection, https://doi.org/10.1007/978-3-319-93320-7_19
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19.2 Electrocardiography LVH Electrocardiographic (ECG) LVH is a powerful marker of cardiovascular (CV) morbidity/mortality in the general population as well as in different clinical settings [2]. In hypertensive patients, LVH may predict the occurrence of CV events, including myocardial infarction, stroke, sudden death, and heart failure [3, 4]. The incidence of cardiac arrhythmias [5], in particular of atrial fibrillation [6] and of renal events, such as creatinine doubling, estimated glomerular filtration rate
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