Assessment of Target Organ Damage Established and Novel

Assessment of Target Organ Damage: Established and Novel Methods Christian Delles BHF Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow

Cardiovascular Risk Joint British Societies

Organ Damage and Cardiovascular Risk 2013 ESH/ESC Guidelines. J Hypertens 2013

The Cardiovascular Continuum Dzau V et al. Circulation 2006

Subclinical Organ Damage and CV Risk Study Condition Organ damage 10 yr CVD ≥ 20% Tsioufis Mihani CASE-J trial CV Health Study ELSA Laurent Fowkes De Buyzere Koren Tsioufis HOT INSIGHT Jensen Hypertension Outpatients Hypertension Elderly Hypertension Outpatients Hypertension Hypertension LVH (echo) Ca IMT (highest quintile) Ca IMT (2 highest quintiles) PWV (highest quintile) Ankle / brachial ratio LVH (echo) Low e. GFR or high SCR (≥ 1. 5 mg/dl) MA Yes Yes (men) Yes Yes Yes (CHD) ESH Taskforce Document. J Hypertens 2009

Heart

ECG: Indices of Left Ventricular Hypertrophy Sokolow-Lyon Index: SV 1 + RV 5/6 ≥ 3. 8 m. V (3. 5 m. V) Cornell Voltage Product: Men: (Ra. VL + SV 3) × QRS > 244 m. V msec Women: (Ra. VL + SV 3 +0. 8) × QRS > 244 m. V msec Schmieder RE. Dtsch Arztebl Int 2010

ECG: Sokolow-Lyon Index e-cardiogram. com

ECG Voltage Criteria and CV Events Levy D at al. Circulation 1994

Echocardiography

Echocardiography 2013 ESH/ESC Guidelines. J Hypertens 2013

Left Ventricular Mass and CV Events Schillaci G et al. Hypertension 2000

Cardiac Damage The ECG is valuable [for detection of LVH], at least in patients over 55 years of age. Electrocardiography can also be used to detect patterns of ventricular overload or ‘strain’, which indicates more severe risk, ischaemia, conduction abnormalities, left atrial dilatation and arrhythmias, including atrial fibrillation. 2013 ESH/ESC Guidelines. J Hypertens 2013

Cardiac Damage Echocardiography should be considered in hypertensive patients in different clinical contexts and with different purposes: • in hypertensive patients at moderate total CV risk, it may refine the risk evaluation by detecting LVH undetected by ECG • in hypertensive patients with ECG evidence of LVH it may more precisely assess the hypertrophy quantitatively and define its geometry and risk • in hypertensive patients with cardiac symptoms, it may help to diagnose underlying disease. 2013 ESH/ESC Guidelines. J Hypertens 2013

Blood Vessels

The Cardiovascular Continuum Dzau V et al. Circulation 2006

Endothelial Function: Flow-mediated Dilatation

Vascular Stiffness and CV Events Willum-Hansen T et al. Circulation 2006

Blood Pressure Determines CV Risk Prospective Studies Collaboration. Lancet 2002

Pulse Pressure Refines CV Risk Franklin SS et al. Circulation 1999

Atherosclerosis and Vascular Stiffness Wikipedia. org Ng et al. Am J Physiol Renal Physiol 2011

Vascular Stiffness: Pulse Wave Velocity

Vascular Stiffness and Mortality Parameters OR Lower 95% CI Higher 95% CI P PWV, 5 m/s 2. 35 1. 76 3. 14 <0. 0001 Previous CVD, yes/no 14. 81 7. 98 27. 47 <0. 0001 Age, 10 y 2. 32 1. 78 3. 01 <0. 0001 PP, 10 mm Hg 1. 53 1. 31 1. 80 <0. 0001 SBP, 10 mm Hg 1. 26 1. 12 1. 42 <0. 001 Diabetes, yes/no 4. 23 1. 96 9. 15 <0. 001 Relative Risk of Cardiovascular Mortality According to PWV and Cardiovascular Risk Factors: Univariate Analysis Laurent S et al. Hypertension 2001

Carotid Intima-Media Thickness Healthy subject Patient with arterial hypertension and hypercholesterolaemia Barth JD. Am J Cardiol 2002