End organ damage in arterial hypertension and cardiovascular risk

Authors: J. Václavík
Published in: Kardiol Rev Int Med 2013, 15(4): 211-217


Arterial hypertension leads to a subclinical end organ damage, which increases patients‘ total cardiovascular risk. Hypertensive heart disease can be diagnosed as left ventricular hypertrophy by echocardiography or several electro­cardiographic indices. Arterial wall damage is assessed by carotid ultrasound by a measurement of intima-media thickness, as well as by carotid-femoral pulse-wave velocity or ankle-brachial index. Albumin­uria and estimated glomerular filtration rate are evaluated to diagnose hypertensive nephropathy. Cerebrovascular damage, including microangiopathic changes, is best diagnosed by magnetic resonance imaging. In case of confirmed subclinical organ damage, antihypertensive drug treatment should be initiated immediately and the type of drug chosen accordingly, usually including an inhibitor of the renin-angiotensin system.

hypertension – end organ damage – target organ damage – left ventricular hypertrophy – nephro­pathy – vasculopathy – cardiovascular risk


1. Cífková R, Bruthans J, Adámková V et al. Prevalence základních kardiovaskulárních rizikovych faktorů v české populaci v letech 2006–2009. Studie Czech post-MONICA. Cor Vasa 2011; 53: 220–229.

2. Schmieder RE. End organ damage in hypertension. Dtsch Arztebl Int 2010; 107: 866–873.

3. Franco OH, Peeters A, Bonneux L et al. Blood pres­sure in adulthood and life expectancy with cardiovascular disease in men and women: life course analysis. Hypertension 2005; 46: 280–286.

4. Mancia G, Fagard R, Narkiewicz K et al. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the management of arterial hypertension. J Hypertens 2013; 31: 1925–1938.

5. Daniels SD, Meyer RA, Loggie JM. Determinants of cardiac involvement in children and adolescents with essential hypertension. Circulation 1990; 82: 1243–1248.

6. Post WS, Larson MG, Levy D. Impact of left ventricular structure on the incidence of hypertension. The Framingham Heart Study. Circulation 1994; 90: 179–185.

7. Dzau VJ. Tissue renin-angiotensin system in myocardial hypertrophy and failure. Arch Intern Med 1993; 153: 937–942.

8. Alfakih K, Maqbool A, Sivananthan M et al. Left ventricle mass index and the common, functional, X-linked angiotensin II type-2 receptor gene polymorphism (-1332 G/A) in patients with systemic hypertension. Hypertension 2004; 43: 1189–1194.

9. Alfakih K, Walters K, Jones T et al. New gender-specific partition values for ECG criteria of left ventricular hypertrophy: recalibration against cardiac MRI. Hypertension 2004; 44: 175–179.

10. Lang RM, Bierig M, Devereux RB et al. Recom­mendations for chamber quantification. Eur J Echocardiogr 2006; 7: 79–108.

11. Armstrong AC, Gidding S, Gjesdal O et al. LV mass assessed by echocardiography and CMR, cardio­vascular outcomes, and medical practice. JACC Cardiovasc Imaging 2012; 5: 837–848.

12. Milani RV, Lavie CJ, Mehra MR et al. Left ventricular geometry and survival in patients with normal left ventricular ejection fraction. Am J Cardiol 2006; 97: 959–963.

13. Devereux RB, Roman MJ, Ganau A et al. Cardiac and arterial hypertrophy and atherosclerosis in hypertension. Hypertension 1994; 23: 802–809.

14. Verdecchia P, Carini G, Circo A et al. Left ventricular mass and cardiovascular morbidity in essential hyper­tension: the MAVI study. J Am Coll Cardiol 2001; 38: 1829–1835.

15. Beache GM, Herzka DA, Boxerman JL et al. Attenuated myocardial vasodilator response in patients with hypertensive hypertrophy revealed by oxygenation-dependent magnetic resonance imaging. Circulation 2001; 104: 1214–1217.

16. Klingbeil AU, Schneider M, Martus P et al. A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension. Am J Med 2003; 115: 41–46.

17. Chambless LE, Folsom AR, Clegg LX et al. Carotid wall thickness is predictive of incident clinical stroke: the Atherosclerosis Risk in Communities (ARIC) study. Am J Epidemiol 2000; 151: 478–487.

18. Touboul PJ, Hennerici MG, Meairs S et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis 2012; 34: 290–296.

19. Williams B, Lacy PS, Thom SM et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 2006; 113: 1213–1225.

20. Chen X, Wen W, Anstey KJ et al. Prevalence, incidence, and risk factors of lacunar infarcts in a community sample. Neurology 2009; 73: 266–272.

21. Arboix A, Martí-Vilalta JL, Pujol J et al. Lacunar cerebral infarct and nuclear magnetic resonance. A review of sixty cases. Eur Neurol 1990; 30: 47–51.

22. Jokinen H, Kalska H, Mäntylä R et al. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. J Neurol Neurosurg Psychiatry 2005; 76: 1229–1233.

23. Vermeer SE, Longstreth WT Jr, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol 2007; 6: 611–619.

24. Conijn MM, Kloppenborg RP, Algra A et al. Cerebral small vessel disease and risk of death, ischemic stroke, and cardiac complications in patients with atherosclerotic disease: the Second Manifestations of ARTerial disease-Magnetic Resonance (SMART-MR) study. Stroke 2011; 42: 3105–3109.

25. van den Born BJ, Hulsman CA, Hoekstra JB et al. Value of routine funduscopy in patients with hypertension: systematic review. BMJ 2005; 331: 73.

26. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2013; 3 (Suppl): 136–150.

27. Levey AS, Coresh J, Greene T et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006; 145: 247–254.

28. Levey AS, Stevens LA, Schmid CH et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604–612.

29. Sarafidis PA, Bakris GL. Resistant hypertension: an overview of evaluation and treatment. J Am Coll Cardiol 2008; 52: 1749–1757.

30. Filipovský J, Widimský J jr, Špinar J. Doporučení ESH/ESC pro diagnostiku a léčbu hypertenze – verze 2013. Zkrácený překlad. Hypertenze Kardiovask Prevence 2013; 5: 4–18.

Paediatric cardiology Cardiac surgery Cardiology
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account