Daño a Organo Blanco Hipertension

MEDICINE

REVIEW ARTICLE

End Organ Damage In Hypertension
Roland E. Schmieder

SUMMARY
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 andEuropean 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 aidof 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. ►Cite this as: Schmieder RE: End organ damage in hypertension. Dtsch Arztebl Int 2010; 107(49): 866–73. DOI: 10.3238/arztebl.2010.0866

ypertension is the leadingrisk factor for morbidity and mortality throughout the world (1). The early detection and severity of typical end organ damage and secondary diseases are key determinants of cardiovascular prognosis in patients suffering from arterial hypertension (2). The classic manifestations of hypertensive end organ damage include the following: vascular and hemorrhagic stroke, retinopathy, coronary heartdisease/myocardial infarction and heart failure, proteinuria and renal failure and in the vasculature, atherosclerotic change including the development of stenoses and aneurysms (Figure 1). The recommendations of medical societies specializing in hypertension have not only used blood pressure for risk stratification, but focus on additional cardiovascular risk factors, the detection of end organdamage, and clinically manifest cardiovascular diseases (2, 3). Hence, grade 1 hypertension can be associated with a slightly increased risk or with a very significantly increased risk depending on what additional end organ damage is present (Table 1).

H

Early detection
The early detection of hypertensive end organ damage can slow or prevent damage, or allow disease regression with adequatetherapy, where organ damage is still at a reversible stage. The diagnosis of hypertensive end organ damage is of decisive importance. This is reflected in European and German guidelines (2, 3). On the basis of these guidelines and a selective literature review of the past 15 years’ literature, this article will discuss early hypertensive end organ damage, its pathogenesis, diagnosis, and therapy(Box).

Pathogenesis
Increasing the arterial blood pressure leads to organ damage via hemodynamic load. Currently, 24-hour ambulatory blood pressure measurement is the chosen method of measuring cardiovascular load. Several studies have found that hypertensive end organ damage and its modification with treatment correlate more closely with ambulatory 24-hour blood pressure measurement than withoffice based blood pressure readings (e1). Ambulatory 24-hour blood pressure measurement is not associated with a white coat effect, except for the first two measurements when attaching the device in the doctor’s office. This technique is also used to diagnose masked hypertension (normal values in the doctor’s office, but not in daily life) (e1).
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