Evaluation of subclinical target organ damage for risk assessment and treatment in the. Subclinical organ damage in the initial evaluation in patients with hypertension. Resistant hypertension rh is associated with a higher risk of cv complications and a higher prevalence of target organ damage tod. The present paper will discuss the importance of the initial evaluation of target organ damage in hypertensive patients and will present the evidence for using changes in subclinical organ damage as surrogate endpoints.
Healthy people 2010 the public health service phs is committed to achieving the health promotion and disease prevention objectives of healthy people 2010, a phsled national activity for setting priority areas. Prevalence and clinical correlates of microalbuminuria in. An essential tool for everyday use in managing hypertension, this book covers the different phases of. The korean registry of target organ damage in hypertension aims to evaluate the clinical characteristics and prevalence of subclinical target organ damage in korean hypertensive patients. Is a type of hypertension which by definition is caused by an identifiable underlying secondary cause. The book discusses not only the relationship between hypertension and stroke, but also the much less studied relationship between hypertension and cognitive decline and neurodegenerative diseases such as alzheimers. Within the hypertensive crises, hypertensive emergencies account for only around onefourth of.
Hypertension has been presumed to cause endorgan damage in the kidney. Hypertension oxford cardiology library oxford medicine. This special issue is related to the main concern in hypertensive disease. Acute endorgan damage in the setting of a hypertensive emergency may include the followingref12. Their objectives were to identify new research directions that elucidate the basic biophysical and biological mechanisms underlying organ damage in hypertension and that lead to development of preclinical and presymptomatic markers of organ damage to allow early.
Inflammation, immunity, and hypertensive endorgan damage. However, chronically sustained ht can damage the eyes, kidneys, brain, and cardiovascular system. Hypertension is associated with early abnormalities in heart, kidney, and vessels, including development of left ventricular lv hypertrophy lvh, microalbuminuria and increased carotid intimamedia thickness imt, markers of target organ damage tod. Hypertension injures blood vessels and thereby causes endorgan damage. In the present study, the influence of sodium intake estimated by two consecutive measurements of 24h urinary sodium excretion on target organ damage left ventricular mass and microalbuminuria was assessed in a large group of normotensive and nevertreated patients with essential hypertension. In this paper, we will focus on microvascular changes in relation to hypertension and target organ damage as well as potential therapeutic interventions. The aim of the present study was to estimate the prevalence of target organ damage in primary care subjects. Acute end organ damage in the setting of a hypertensive emergency may include the followingref12. This is a prospective, observational, multicenter cohort study in which 23 university hospitals participated.
Hypertension is a well known risk factor for cardiovascular and cerebrovascular events such as heart attacks and strokes. Service providers ensure systems are in place for people with newly diagnosed hypertension to receive all investigations for target organ damage within 1 month of diagnosis. Hypertension revision notes the medical textbook free. Methods we did a metaanalysis of prospective and retrospective observational studies that compared patients with. The selected papers approach some aspects of renal and cerebral disease associated to hypertension but the principal focus is on the arterial vessel as the main organ involved in hypertensive patients. Evaluation of subclinical target organ damage for risk. Platelet activation, endothelial dysfunction and altered angiogenesis play an important part in the pathophysiology of target organ damage in hypertension. Damage to these organs typically manifests as coronary heart disease, heart failure, stroke, other cardiovascular diseases and impaired renal function or endstage kidney failure. Hypertension clinical manifestations sx often secondary to target organ disease can include. Genetic variants in novel pathways influence blood pressure and cardiovascular disease risk. Target organ damage and target systolic blood pressure in. Primary hypertension participates actively in the development of cardiac coronary artery disease, heart failure, and atrial fibrillation, cerebral stroke and transient ischaemic attack, and peripheral arterial disease.
Target organ damage and incident type 2 diabetes mellitus. The regional consultation on hypertension prevention and control held in abu dhabi, united arab emirates, 2022 december 2003, acknowledged the need for a standardized response to the growing challenge of hypertension see annex 1. End organ damage in hypertension pubmed central pmc. Examples are left ventricular hypertrophy, chronic kidney disease, hypertensive retinopathy or increased urine albumin.
In summary, despite some limitations, the report by ji and coworkers adds a very important piece in the puzzle of the complex relationship between vascular aging and target organ damage involving lvh, lv diastolic dysfunction and microalbuminuria. Mechanisms of target organ damage caused by hypertension. Hypertension discriminates poorly among target organs and quite often adversely affects the heart and kidney simultaneously. Evaluation of hypertension and related target organ damage. Service providers ensure systems are in place for people with newly diagnosed hypertension to receive all investigations for target organ damage within 1 month of diagnosis healthcare professionals carry out all investigations for target organ damage for people with newly diagnosed hypertension within 1 month of diagnosis. End organ damage is defined as presence of any one or more of the following features. In the context of hypertension features looked for, at least in the initial workup, include. What the quality statement means for each audience. May 18, 2017 over the course of its natural history, essential hypertension progresses from occasional to established hypertension. Hypertension is the leading risk factor for morbidity and mortality throughout the world 1. May 01, 2006 recommendations for pharmacologic treatment are based on symptomatic hypertension, evidence of end organ damage, stage 2 hypertension, stage 1 hypertension unresponsive to lifestyle modifications. Several antihypertensive agents have been shown to attenuate end organ damage and to reduce effectively hypertensionassociated cardiovascular events.
It sheds light on current international guidelines by directly applying them to six representative clinical cases that reflect situations frequently encountered during clinical routine rather than emergencies or rare occurrences. Jul 05, 2012 this special issue is related to the main concern in hypertensive disease. Similar to arterial hypertension and obesity, type 2 diabetes mellitus is associated with target organ damage tod 1,2,3. Damage to organs such as the heart, brain, kidneys and eyes. Assessment of target organ damage tod for cardiovascular risk. Terms in this set 21 most common causes of hypertension. Idiopathic primary consequences of hypertensionaccelerate artherosclerosisvascular remodeling leading ot increased. Nices guideline on hypertension in adults, terms used in this guideline. The management of hypertension varies considerably from clinician to clinician. Jul 14, 2011 except for the established risk factors, presence of target organ damage has an important role in the treatment of hypertensive subjects. Primary and secondary hypertension and target organ damage. The selected papers approach some aspects of renal and cerebral disease associated to hypertension but the principal focus is on the arterial vessel. Bibtex bookends easybib endnote tagged endnote 8 xml medlars.
Once the diagnosis of hypertension has been appropriately made and secondary causes considered, the remainder of the evaluation should be directed toward the identification of target organ damage, an assessment of other cardiovascular risk factors, and identification of comorbid conditions that may influence the therapeutic decisionmaking process. Chest pain may indicate myocardial ischemia or infarction, back pain may denote aortic dissection. A 10year cardiovascular risk equivalent to 20% or greater. This multicentre, crosssectional survey of 115 primary care physicians recruited 1095 consecutive subjects with hypertension. Since may 20, we have enrolled 1,318 consecutive hypertensive patients without known. Hypertension in children and adolescents american family. An open level retrospective cohort study has been employed at cardiac clinic of gondar university hospital for a mean followup. Early onset hypertension confers increased risk for cardiovascular mortality in the community. Target organ damage mainly cardiac and renal damage is easy to evaluate in outpatient clinics and offers valuable information about patients cardiovascular risk. Target organ damage in hypertension oxford medicine. Target organ damage includes microvascular retinopathy nephropathy, vascular dementia and macrovascular injuries stroke and myocardial infarctions. Patients may complain of specific symptoms that suggest endorgan dysfunction may be present. The purpose of this study was to evaluate, using simple methods, the prevalence of cardiac and renal damage and its relationship to the presence of established cardiovascular disease cvd, in patients with hypertension ht and.
The early detection and severity of typical end organ damage and secondary diseases are key. Mechanisms in hypertension and target organ damage. The assessment of blood pressure control and target organ damage in patients with chronic kidney disease and hypertension aprodite study was a nationwide, crosssectional study conducted at 21. Offer antihypertensive drug treatment to people of any age with stage 2 hypertension. There was limited published data on target organ damage tod and the effect of nonadherence to practice guidelines in ethiopia.
The relation of masked hypertension to target organ damage has very seldom been investigated in a general population. Morbidity and mortality associated with hypertensionmediated damage in these two organ systems is linked to two culprit syndromes in particularcardiorenal and pickering syndromes. Public users are able to search the site and view the abstracts for each book and chapter without a subscription. Dietary sodium and target organ damage in essential hypertension. Hypertension and renal organ damage practical case studies. This online resource is a concise and evidencebased summary of current understanding and practice, including the most uptodate guidance from national bodies and their recommendations for hypertension care.
Which symptoms of hypertensive emergencies may indicate. Albuminuria was measured as the albumintocreatinine ratio in three nonconsecutive, first morning urine samples. Hypertension, target organ damage, endothelial activation, platelet activation. This rfa, susceptibility to target organ damage in high blood pressure, is related to one or more of the priority areas. Pwv and central augmentation index caix novel parameters of tod. The national heart lung and blood institute convened a working group of investigators on june 2425, 2008 in bethesda, maryland. Determinants of hypertensive left ventricular hypertrophy. Recommendations for pharmacologic treatment are based on symptomatic hypertension, evidence of endorgan damage, stage 2 hypertension, stage 1. Indeed, these factors are interrelated and appear to play a key role in the development of organ dysfunction.
Hypertension, if not controlled, causes alterations of the retinal microcirculation. 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. Table 11 lists example conditions that, when accompanied by high blood pressure, define hypertensive emergency. The treatment of end organ damage due to hypertension centers on. Pdf renal function and target organ damage in hypertension. Target organ damage in hypertension national heart, lung. In patients with chronic kidney disease, data on blood pressure bp pattern and its. Target organ damage in hypertension pubmed central pmc. The relationship of blood pressure bp of morbidity and mortality from. After a long, invariable, asymptomatic period, persistent hypertension develops into complicated hypertension, in which target organ damage to the aorta and small arteries, heart, kidneys, retina, and central nervous system is evident. This book identifies the key determinants in the management of hypertensive outpatients with cardiac target organ damage. The first comprehensive overview of the effects of hypertension on the brain. Abstract the prevalence of microalbuminuria and its relationship with several cardiovascular risk factors and target organ damage were evaluated in a cohort of 787 untreated patients with essential hypertension.
Hypertension and renal organ damage practical case studies in hypertension management pontremoli, roberto on. Hypertension and renal organ damage practical case. The heart, kidney, and brain as target organs in hypertension. Lvm was measured at the end of ventricular diastole by multiplying the. Mar 20, 20 what the quality statement means for each audience. In a large series of renal biopsies in patients with essential hypertension, arterionephrosclerosis was present in 81. Early onset hypertension is associated with hypertensive.
The heart, kidney, brain, and arterial blood vessels are prime targets of hypertensive damage. Target organ damage in essential hypertension, genetics and pathophysiology of essential hypertension, madhu khullar, intechopen, doi. Hypertension and renal organ damage practical case studies in hypertension management. You have free access to this content the journal of clinical hypertension volume 15, issue 10, version of record online. Renal function and target organ damage in hypertension. In summary, this special issue covers a wide range of target organ damage associated to hypertension, with a special attention to the vessel as the central key not only for vascular disease but also for cardiac, cerebral, and renal complications in hypertensive patients. Although hypertensive emergencies can lead to significant morbidity and potentially fatal targetorgan damage, only 1%3% of patients with hypertension will have a hypertensive emergency during their lifetime deshmukh 2011. Hypertension and cardiac organ damage raffaele izzo.
What endorgan damage may occur during a hypertensive emergency. Blood pressure pattern and target organ damage in patients with. Association between blood pressure and target organ damage. Nice suggest using the following algorithm for initiating treatment for hypertension. The mechanisms are complicated and, although studied for decades in experimental animal models, 1 are only currently being elucidated. Hypertension is associated with a prothrombotic state. Assessment of target organ damage in the evaluation and. The myriad pathophysiological mechanisms associated with the spectrum of target organ damage are shown in table 1. Raised systolic blood pressure bp is a powerful independent risk factor for cardiovascular mortality. End organ damage usually refers to damage occurring in major organs fed by the circulatory system heart, kidneys, brain, eyes which can sustain damage due to uncontrolled hypertension, hypotension, or hypovolemia.
In addition, it is associated with earlier changes in organ systems in the body, such as left ventricular hypertrophy lvh, proteinuria and renal failure, retinopathy and vascular dementia which are grouped under the term target organ damagetod. Target organ damage and cardiovascular complications in. However, even when blood pressure is under control, organ damage and. The classic manifestations of hypertensive end organ damage include the following. What endorgan damage may occur during a hypertensive. Although hypertensive emergencies can lead to significant morbidity and potentially fatal targetorgan damage, only 1%3% of patients with hypertension will have a hypertensive emergency. Except for the established risk factors, presence of target organ damage has an important role in the treatment of hypertensive subjects.
The study was conducted in 102 subjects with borderline, moderate and severe hypertension. From the efforts of many investigators, we are now in the position of constructing a chain of events from the endothelium to the underlying. Spectrum of hypertensionrelated target organ damage. Cardiovascular events and target organ damage in primary. Relationship between target organ damage and blood pressure. The presence of ckd, usually considered as a form of target organ damage, can be detected throughout the cv continuum. Hypertension has been presumed to cause end organ damage in the kidney.
A multicenter cohort study of primary hypertension in. Damage to these organs typically manifests as coronary heart disease, heart failure, stroke, other cardiovascular diseases and impaired renal function or end stage kidney failure. Uncontrolled hypertension accelerates the damage to these organs and results in eventual organ failure and cardiovascular death and disability. End organ damage in hypertension can be detected early, reflects accurately the hypertensive patients overall cardiovascular risk, and should be prevented and treated with antihypertensive treatment. Target organ damage in essential hypertension intechopen. In addition, it is associated with earlier changes in organ systems in the body, such as left ventricular hypertrophy lvh, proteinuria and renal failure, retinopathy and vascular dementia which are grouped under the term target organ damage tod. Target organ damage includes microvascular retinopathy nephropathy, vascular dementia and. Introduction target organ damage tod is associated with increased. However, the sequence between major cv risk factor and tod has been brought into question by evidence that sometimes tod precedes the clinical appearance of the disease that is thought to cause it.
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