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Review
. 2010 Dec;107(49):866-73.
doi: 10.3238/arztebl.2010.0866. Epub 2010 Dec 10.

End organ damage in hypertension

Roland E Schmieder  1
Affiliations
Review

End organ damage in hypertension

Roland E Schmieder. Dtsch Arztebl Int. 2010 Dec.

Abstract

Background: End organ damage in hypertension can be detected early, reflects accurately the hypertensive patient's overall cardiovascular risk, and should be prevented and treated with antihypertensive treatment.

Method: We selectively review the relevant literature since 1995, including the German and European guidelines for the diagnosis and treatment of arterial hypertension.

Results: Measurement of the intima-media thickness in the common carotid artery and of the pulse-wave velocity is now recommended for the early diagnosis of hypertensive vasculopathy. Left ventricular hypertrophy, an important component of hypertensive heart disease, can be diagnosed by echocardiography and with the aid of new electrocardiographic indices. Early signs of hypertensive nephropathy, namely albuminuria and a decreased glomerular filtration rate, are prognostically valuable and easy to detect. Cerebrovascular damage, including early microangiopathic changes, is best diagnosed by magnetic resonance imaging. The treatment of end organ damage due to hypertension centers on blood pressure reduction. Blockade of the renin angiotensin-aldosterone system is an essential part of the treatment of early end organ damage.

Conclusion: Hypertensive end organ damage can now be diagnosed early and reversed with specific and aggressive treatment.

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Figures

Figure 1
Figure 1
Reversible and irreversible end organ damage in arterial hypertension; CHD, coronary heart disease
Figure 2
Figure 2
Measurement of generalized vasculopathy (adapted according to [e25]); P, intra-arterial pressure; Esp, augmentation pressure; Sp, systolic blood pressure; PP, pulse pressure (blood pressure amplitude); MP, mean arterial pressure; ED, enddiastolic; ES, endsystolic
Figure 3
Figure 3
Hypertensive heart disease: pathogenetic factors and clinical presentation. PWV, pulse wave velocity; FH, family history; LVH, left ventricular hypertrophy; LV, left ventricle
Figure 4
Figure 4
ECG for the diagnostic evaluation of left ventricular hypertrophy
Figure 5
Figure 5
Albuminuria as a prognostic marker for terminal chronic renal failure; ACR, albumin-creatinine ratio; NKF, National Kidney Foundation; FDA, Food and Drug Administration; ESRD, end-stage renal disease; eGFR, calculated glomerular filtration rate
See this image and copyright information in PMC

Comment in

  • Not very meaningful.
    Schneider T. Schneider T. Dtsch Arztebl Int. 2011 Mar;108(11):187; author reply 187-8. doi: 10.3238/arztebl.2011.0187a. Epub 2011 Mar 18. Dtsch Arztebl Int. 2011. PMID: 21475567 Free PMC article. No abstract available.
  • Retinopathy as a differential diagnosis.
    Schmidt D. Schmidt D. Dtsch Arztebl Int. 2011 Mar;108(11):187; author reply 187-8. doi: 10.3238/arztebl.2011.0187b. Epub 2011 Mar 18. Dtsch Arztebl Int. 2011. PMID: 21475569 Free PMC article. No abstract available.

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