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Most advisable strategy in search of asymptomatic target organ damage in hypertensive patients

J Abellán-Huerta1, L Prieto-Valiente2, L Consuegra-Sánchez1

  • 1Departamento de Cardiología, Hospital General Universitario Santa Lucía, Cartagena, Spain.

Hipertension Y Riesgo Vascular
|May 20, 2017
PubMed

Insights

A step-by-step approach using widely available tests like GFR, ACR, ABI, and ECG, followed by carotid ultrasound and pulse wave velocity, is effective for detecting target organ damage in hypertensive patients.

Area of Science:

  • Cardiology
  • Nephrology
  • Vascular Medicine

Background:

  • Hypertension is a major risk factor for cardiovascular and renal diseases.
  • Early detection of target organ damage (TOD) is crucial for managing hypertensive patients.
  • Optimal diagnostic strategies for TOD are still being defined.

Purpose of the Study:

  • To evaluate seven diagnostic examinations for target organ damage (TOD) in hypertensive patients.
  • To define the most suitable strategy for searching TOD.
  • To assess the performance of widely available tests and guide the sequence of further investigations.

Main Methods:

  • A descriptive, cross-sectional study included 153 treated and essential hypertensive patients without established cardiovascular or advanced renal disease.
  • Examinations included: glomerular filtration rate (GFR), albumin/creatinine ratio (ACR), electrocardiogram (ECG), echocardiogram (ECO), ankle-brachial index (ABI), pulse wave velocity (PWV), and carotid ultrasound.
  • The study aimed to determine the effectiveness of a sequential diagnostic approach.

Main Results:

  • 82.6% of patients exhibited some form of TOD.
  • Initial tests (GFR, ACR, ABI, ECG) identified 37% of TOD cases.
  • Adding carotid ultrasound increased TOD detection to 70% and improved classification accuracy to 89%.
  • Pulse wave velocity (PWV) identified 78% of TOD+ patients, with 96% overall correct classification; echocardiogram (ECO) had a minor contribution.

Conclusions:

  • A sequential strategy starting with GFR, ACR, ABI, and ECG is recommended for TOD screening.
  • Incorporating carotid ultrasound and PWV enhances the detection of TOD in asymptomatic hypertensive individuals.
  • This step-by-step approach optimizes the search for target organ damage in hypertension management.
Abstract

Keywords:
Ambulatory blood pressure/home blood pressure monitorArteriopatía hipertensivaCardiopatía hipertensivaEstratificación de riesgoHypertension-vascular diseaseHypertensive heart diseaseMedición ambulatoria de la presión arterialNefropatía hipertensivaRenal diseaseRisk assessment

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