Arterial hypertension and organ damage: damage marker

  1. GASTROEPATO
  2. Neurology
  3. Arterial hypertension and organ damage: damage marker
  4. Vascular cerebral insufficiency
  5. Cerebral stroke, stroke or apoplexy
  6. Hemorrhagic stroke
  7. Occlusive pathology of cerebral arteries
  8. How to evaluate a patient with stroke
  9. Cerebral embolism of cardiac origin
  10. Why coma

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Hypertension

What the ESH-ESC guidelines recommend

Hypertrophic heart disease

Focus on arterial hypertension 

Complications in hypertension 

The difficult treatment of hypertension
gica 

Cardiac organ damage markers

In the past, in the 1970s, the diagnosis was made by observing a chest X-ray with a study of cardiac shadow and mediastinal profiles; the cardiac profile and the various curves were studied:

1. lower right corner right atrium

2. upper right arch, superior vena cava;

3. left middle arch, pulmonary artery

4. aortic arch

5. left lower arch, left ventricle.If this last arch can appear excessive, made the measures, for hypertrophy of the left ventricle. On the other hand, if the right-side sections are hypertrophic, we think of pressure overload on the right with a condition of pulmonary stenosis, pulmonary hypertension. The volume overload on the right could assume a defect of the interatrial septum. Left overload is determined by aortic valve stenosis, aortic coarctation, systemic hypertension.

The markers of organ damage with greater cardiovascular prognostic value are:
• Cardiac damage: Left ventricular hypertrophy;
• Vascular damage: carotid IMT (mean intimal thickness), arterial stiffness, arm-ankle index and endothelial dysfunction.
The presence and extent of organ damage is however influenced by numerous variables, including the degree and duration of hypertension, bio-temporal and hormonal factors, genetic predisposition, coexistence of other risk factors, and pharmacological treatment. endothelial dysfunction;
• Renal damage: Reduced GFR and microalbuminuria.

ECG is the simplest method for diagnosing IVS. One of the classic criteria used is that based on the Sokolow-Lyon index. It is necessary to proceed by measuring the following parameters in the cardiac track: S wave in V1 + wave R in V5 or V6 Cut-off: ≥35 mm. Another often used index is the "Cornell voltage" R in aVL + S in V3 Cut-off:> 28 mm (men),> 20 mm (women)indice di Sokolow-Lyon


A further index, which takes into account the slight widening of the QRS often associated with IVS is linked to a delay of intramyocardial conduction, is the "Cornell product" "Cornell voltage" index · QRS duration Cut-off: ≥2440 mV · ms

However, the guidelines state that the most reliable method for diagnosing left ventricular hypertrophy is echocardiography, which is included in the current European Guidelines (ESH / ESC Guidelines for the Management of Arterial Hypertension) among the "recommended" exams in the initial assessment of the hypertensive patient. This echocardiographic method allows the echocardiographic measurement of the VS mass. It is generally based on measurement of parietal thicknesses and left ventricular diameter in cut-off telediastole: ≥125 g / m2 (men), ≥110 g / m2 (women). Even in the presence of normal ejection fraction, diastolic dysfunction is a frequent finding in hypertensive patients

Vascular organ damage


The simplest way to evaluate organ damage at the vascular level is to measure the mean-intimal thickness (IMT) at the carotid level. The IMT, easily determinable with ultrasound method, is an early marker of atherosclerosis frequently observable in hypertensive patients. Although generally an IMT> 0.9 mm at the level of the common carotid can be considered pathological, normal values ​​are influenced by age. They also vary according to the studied carotid segment (eg common carotid, bifurcation, etc ...).
However, IMT is a powerful independent predictor of cardiovascular events. In the recent ELSA study, conducted on 2,334 hypertensive patients, a 0.1 mm increase in IMT corresponded to a 25-35% increase in the risk of cardiovascular events. Pulse wave velocity measurement, generally calculated between common carotid and femoral artery, provides an estimate of arterial stiffness. A value> 12 m / s suggests the presence of increased stiffness. Pulse wave velocity is an independent predictor of cardiovascular events in hypertensive patients. A further method for assessing the presence of vascular organ damage is the measurement of the ankle-arm index. In the recent PAMISCA study, an ankle-arm index <0.9 was found to be an independent predictor of cardiovascular events in 1101 hypertensive patients with sindrome coronarica acuta.

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