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

Joint British Societies Cardiovascular Risk

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

Dzau V et al. Circulation 2006 The Cardiovascular Continuum

ESH Taskforce Document. J Hypertens 2009 Subclinical Organ Damage and CV Risk Study Tsioufis Mihani CASE-J trial CV Health Study ELSA Laurent Fowkes De Buyzere Koren Tsioufis HOT INSIGHT Jensen Condition Hypertension Outpatients Hypertension Elderly Hypertension Outpatients Hypertension 10 yr CVD ≥ 20% Yes Yes (men) Yes Yes (CHD) Organ damage LVH (echo)  Ca IMT (highest quintile)  Ca IMT (2 highest quintiles) PWV (highest quintile)  Ankle / brachial ratio LVH (echo) Low eGFR Low eGFR or high SCR (≥ 1.5 mg/dl) MA

Heart

Schmieder RE. Dtsch Arztebl Int 2010 ECG: Indices of Left Ventricular Hypertrophy Sokolow-Lyon Index: S V1 + R V5/6 ≥ 3.8 mV (3.5 mV) Cornell Voltage Product: Men: (R aVL + S V3 ) × QRS > 244 mV msec Women: (R aVL + S V3 +0.8) × QRS > 244 mV msec

e-cardiogram.com ECG: Sokolow-Lyon Index

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

Echocardiography

2013 ESH/ESC Guidelines. J Hypertens 2013

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

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 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 ESH/ESC Guidelines. J Hypertens 2013 Cardiac Damage

Blood Vessels

Dzau V et al. Circulation 2006 The Cardiovascular Continuum

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 Ng et al. Am J Physiol Renal Physiol 2011 Wikipedia.org

Vascular Stiffness: Pulse Wave Velocity

Vascular Stiffness and Mortality Relative Risk of Cardiovascular Mortality According to PWV and Cardiovascular Risk Factors: Univariate Analysis ParametersORLower 95% CIHigher 95% CIP PWV, 5 m/s < Previous CVD, yes/no < Age, 10 y < PP, 10 mm Hg < SBP, 10 mm Hg <0.001 Diabetes, yes/no <0.001 Laurent S et al. Hypertension 2001

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