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Evaluation of organ damage in hypertension
A Zanchetti1, P Sleight, W H Birkenhäger
1Istituto di Clinica Medica, University of Milan, Italy.
Insights
Routine hypertension diagnosis suffices for most, but advanced organ damage evaluation is key for specific cases. Future trials should assess these methods for better hypertension management.
Area of Science:
- Cardiology
- Nephrology
- Ophthalmology
Background:
- Discussions at a Scientific Workshop in Brescia, Italy, considered numerous methods for evaluating organ damage in hypertension.
- Current routine diagnostic procedures for hypertension include clinic blood pressure, retinal examination, electrocardiogram, serum creatinine, and urinalysis.
Purpose of the Study:
- To evaluate the utility of various diagnostic methods for organ damage in hypertensive patients.
- To determine which methods are suitable for routine diagnosis versus specialized investigation.
Main Methods:
- Review of existing and novel methods for assessing organ damage in hypertension.
- Comparison of routine diagnostic tools with more refined techniques like echocardiography.
Main Results:
- Routine diagnostic methods are likely sufficient for most hypertensive patients.
- Echocardiography is the most likely refined method to be included in routine hypertensive patient examinations.
- Other advanced techniques are valuable for specific patient problems or specialized investigations.
Conclusions:
- Future epidemiological and interventional trials in hypertension should incorporate organ damage evaluation.
- Assessing the validity and clinical relevance of abnormalities like left ventricular hypertrophy, reduced coronary reserve, and microalbuminuria is crucial.
- The potential benefits of therapeutically reverting these organ damage alterations require further study.
Introduction:
This document is the result of discussions held during a Scientific Workshop in Brescia, Italy, where the numerous methods, old and new, for evaluation of organ damage in hypertension were considered. Not all of the methods can be recommended as routine diagnostic procedures for every hypertensive subject. Current routine diagnosis of organ damage by clinic blood pressure, retinal appearances, the electrocardiogram, serum creatinine estimation and urinary analysis will probably suffice; of the more refined methods, only the echocardiogram is likely to be often included in the examination of hypertensive patients. All of the other techniques will be useful in the diagnostic approach to patients with particular problems, or for the purposes of special investigation.
Recommendations:
It is recommended that the validity of the methods, the clinical relevance of the abnormalities (including left ventricular hypertrophy, reduced coronary reserve, arterial changes in the eye grounds, reduced large artery compliance and microalbuminuria) and the potential benefits of therapeutically reverting these alterations should be assessed by including organ damage evaluation in future epidemiological and interventional trials in hypertension.