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Should all patients with hypertension have echocardiography?
G de Simone1, G Schillaci, V Palmieri
1Department of Clinical and Experimental Medicine, Federico II University Hospital, School of Medicine, Naples, Italy. simogi@unina.it
Insights
Echocardiography can assess left ventricular mass in hypertension, aiding risk stratification. It
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Imaging
Background:
- Arterial hypertension poses significant cardiovascular risks.
- Accurate risk stratification is crucial for effective management.
- Echocardiography offers valuable insights into cardiac structure and function.
Purpose of the Study:
- To review the feasibility and clinical utility of echocardiography for determining left ventricular (LV) mass.
- To examine the indications for echocardiography in arterial hypertension based on WHO/ISH guidelines.
- To assess the role of echocardiography in cardiovascular risk stratification.
Main Methods:
- Review of current literature on echocardiographic assessment of LV mass.
- Analysis of WHO/ISH guidelines for hypertension management.
- Evaluation of echocardiography's reliability and clinical impact in practice.
Main Results:
- Echocardiography is feasible for determining LV mass and contributes to epidemiological risk stratification.
- Echocardiography is recommended in initial workup for low or mild risk patients (WHO-ISH) or when results influence decisions.
- Insufficient evidence currently supports routine echocardiography for high or very high-risk hypertensive patients.
Conclusions:
- Echocardiography is a reliable tool for LV mass assessment in hypertension.
- Its use is indicated for refining risk stratification and guiding treatment decisions in specific patient groups.
- Further evidence is needed to establish its role in advanced hypertensive disease.
Abstract:
The feasibility of echocardiographic determination of left ventricular (LV) mass, as well as the advantages that might be gained in some clinical circumstances and possible indications are examined in the present review, in relation to the recent WHO/ISH. The information obtained with echocardiograms in arterial hypertension is an important contribution to risk stratification on an epidemiological scale. In clinical practice, under the ascertained condition of a good reliability, an echocardiogram should be recommended as part of the initial work up when patients meet criteria for not starting therapy (low or mild risk WHO-ISH) or in all circumstances in which decision-making might be affected by the echocardiographic result. At present, there is not sufficient evidence to extend the indication of echocardiography also to patients for whom antihypertensive management is already necessitated by identification of high or very high risk status.