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Assessment of Preclinical Organ Damage in Hypertension Assessment of Preclinical Organ Damage in Hypertension Enrico Agabiti Rosei Giuseppe Mancia Editors 123 Assessment of Preclinical Organ Damage in Hypertension Enrico Agabiti Rosei • Giuseppe Mancia Editors Assessment of Preclinical Organ Damage in Hypertension Editors Enrico Agabiti Rosei Giuseppe Mancia Department of Clinical IRCCS Istituto Auxologico Italiano and Experimental Sciences University of Milano-Bicocca University of Brescia Milano Brescia Italy Italy This book is endorsed by the European Society of Hypertension ISBN 978-3-319-15602-6 ISBN 978-3-319-15603-3 (eBook) DOI 10.1007/978-3-319-15603-3 Library of Congress Control Number: 2015940816 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com) Foreword Primary prevention of cardiovascular events and complications in the modern man- agement of hypertension requires precise methods of assessment of preclinical organ damage. This excellent book provides a comprehensive know-how for all clinical practitioners involved in the management of patients with hypertension. There is an excellent coverage of traditional and modern techniques, with all aspects of cardiac, arterial, renal and brain damage evaluation described and illus- trated in detail. This book will facilitate practical management of hypertensive patients according to the current guidelines. It will also allow us to be ready for the future guidelines and recommendations through critical and detailed assessment of new methods and techniques, which are not yet in routine clinical use. One could ask an important question regarding genomics and other “omics”, which are not covered in the text. We are aware that there is a large genetic component (30–50 %) in individuals’ predisposition to hypertension, but further work is necessary to jus- tify large-scale genetic screening for very early prediction of hypertension and car- diovascular disease risk. I believe that the next edition of this book will be able to discuss precision medicine strategies as they develop and mature. In the meantime, the book Assessment of Preclinical Organ Damage in Hypertension will be used by specialist centres and primary care physicians now, and for many years to come, to answer practical questions on management of hypertension. Anna F. Dominiczak, MD, FRCP University of Glasgow, Glasgow, UK v Contents Part I Heart 1 Evaluation of Cardiac Damage in Hypertension: Electrocardiography . 3 Anders M. Greve, Peter M. Okin, Michael Hecht Olsen, and Kristian Wachtell 2 Evaluation of Cardiac Damage in Hypertension: Echocardiography . 13 Enrico Agabiti Rosei and Maria Lorenza Muiesan 3 Modern Diagnostic Approach for the Assessment of Cardiac Damage in Hypertension: 3D, CT and MRI. 25 Athanasios J. Manolis, Eftichia Chamodraka, and Ioanna Zacharopoulou Part II Large Arteries 4 Ultrasound: Carotid Intima-Media Thickness and Plaque (2D–3D). 41 Enrico Agabiti Rosei, Massimo Salvetti, and Maria Lorenza Muiesan 5 Echocardiographic Assessment of the Aorta and Coronary Arteries in Hypertensive Patients . 51 Costas P. Tsioufi s 6 Pulse Wave Velocity and Central Blood Pressure . 63 Stéphane Laurent and Pierre Boutouyrie 7 Ankle-Brachial Index (ABI) . 75 Denis L. Clement 8 Atherosclerosis and General Principles of Arterial Imaging. 81 Isabel Gonçalves, Nuno V. Dias, and Peter M. Nilsson vii viii Contents 9 Imaging and Ageing of the Aorta and Large Arteries in the Lower Extremity. 97 Nuno V. Dias, Isabel Gonçalves, and Peter M. Nilsson Part III Small Arteries 10 Micromyography . 117 Enrico Agabiti Rosei and Damiano Rizzoni 11 Damage of Retinal Arterioles in Hypertension . 127 Christian Ott and Roland E. Schmieder 12 Capillaroscopy . 143 Enrico Agabiti Rosei, Carolina De Ciuceis, and Damiano Rizzoni 13 Other Techniques for the Assessment of Small Artery Damage in Hypertension . 151 Damiano Rizzoni and Claudia Agabiti Rosei Part IV Kidney 14 Proteinuria-Microalbuminuria in Renal Damage. 159 Josep Redon, Gernot Pichler, and Fernando Martinez 15 Glomerular Filtration Rate in Renal Damage. 165 Josep Redon, Gernot Pichler, and Fernando Martinez 16 Other Methods to Assess Renal Damage . 171 Josep Redon, Gernot Pichler, and Fernando Martinez Part V Brain 17 MRI/CT: Evaluation of Brain Damage in Hypertension . 179 Peter Wohlfahrt and Renata Cifkova 18 Questionnaires for Cognitive Function Evaluation . 191 Mónica Doménech, Cristina Sierra, and Antonio Coca 19 Other Techniques for Neurological Damage Evaluation . 197 Cristina Sierra, Mónica Doménech, and Antonio Coca Part VI Relationships Between Target Organ Damage and Blood Pressure Changes 20 Organ Damage and Blood Pressure in Untreated and Treated Hypertensives . 205 Giuseppe Mancia, Cesare Cuspidi, and Sverre E. Kjeldsen Part I Heart Evaluation of Cardiac Damage in Hypertension: Electrocardiography 1 Anders M. Greve , Peter M. Okin , Michael Hecht Olsen , and Kristian Wachtell 1.1 Pathophysiology of Cardiac Target-Organ Damage In the pressure-loaded heart, changes in cardiac structure and function, such as left ventricular (LV) hypertrophy, initially occur as adaptive responses to reduce wall stress and maintain cardiac output. However, depending on a combination of known and lesser understood factors, e.g., antihypertensive therapy, genes, and age, the heart will at a varying pace transition towards increasing cardiac fi brosis, LV dila- tion, pump failure, and ultimately death [1 ]. Importantly, substantial evidence has documented that early identifi cation and therapy aimed at preventing or reversing subclinical cardiac target-organ damage is associated with improved outcomes in A. M. Greve , MD, PhD (*) Department of Medicine , Glostrup University Hospital , Glostrup , Copenhagen 2600 , Denmark e-mail: [email protected] P. M. Okin, MD Division of Cardiology, Department of Medicine , Weill Cornell Medical College , 525 East 68th Street , New York , NY 10065 , USA e-mail: [email protected] M. H. Olsen, MD, PhD, DMSc The Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology , Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital , Sønder Boulevard 29 , Odense 5000 , Denmark e-mail: [email protected] K. Wachtell , MD, PhD, DMSc Department of Medicine , Glostrup University Hospital, Glostrup , Copenhagen 2600 , Denmark Division of Cardiology, Department of Medicine, Weill Cornell Medical College, 525 East 68th Street , New York , NY 10065 , USA Department of Cardiology, Örebro University Hospital, Örebro, Sweden © Springer International Publishing Switzerland 2015 3 E. Agabiti Rosei, G. Mancia (eds.), Assessment of Preclinical Organ Damage in Hypertension, DOI 10.1007/978-3-319-15603-3_1 4 A.M. Greve et al. hypertension [2 ]. In current practice, the treating physician is well equipped to detect and monitor temporal changes in subclinical cardiac target-organ damage. The purpose of this chapter is to give an introduction to the usefulness of electrocar- diography in evaluating patients with hypertension. The fi rst subchapter presents a brief overview of the electrocardiogram in order for the main attention to be focused on the clinical evidence pertaining to its use in assessing cardiac target-organ damage. 1.2 The Electrocardiogram In spite of its centenarian status, the electrocardiogram remains one of the most ubiquitous tools in modern cardiology (>150,000,000 performed per year in the USA and the European Union). Its advantages are clear: it is widely available, can be interpreted without expert knowledge, and provides prognostic information at low cost in patients with and without established cardiovascular disease [3 ]. The basis for electrocardiography is the sequential depolarization of the heart, which under physiologic conditions initiates in the sinoatrial node to move through the cardiac conductive system and reach the ventricular cardiomyocytes via the Purkinje fi bers. The surface electrocardiographic signal is by defi nition positive if the vector of electrical current points towards the electrode and negative if the net fl ux directs away from the electrode. Today’s standard is to use 10 electrodes to construct 12 different leads. Each lead views the depolarization and repolarization of atrial (P-wave) and ventricular (QRS-complex) cardiomyocytes from a different
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