Page 27 - GUIAS ESC ESH 2018

ESC/ESH Guidelines 27

Clinical evaluation and HMOD assessment

Recommendations Class a Level b
Heart
120
12-lead ECG is recommended for all hypertensive patients. I B
Echocardiography:
• Is recommended in hypertensive patients when there are ECG abnormalities or signs or symptoms of LV I B
dysfunction. 42,134
• May be considered when the detection of LVH may influence treatment decisions. 42,134 IIb B
Blood vessels
Ultrasound examination of the carotid arteries: I B

• May be considered for the detection of asymptomatic atherosclerotic plaques or carotid stenosis in patients with docu- IIb B
mented vascular disease elsewhere. 42
Measurement of PWV may be considered for measuring arterial stiffness. 109,189 IIb B

Measurement of ABI may be considered for the detection of advanced LEAD. 153,190 IIb B
Kidney
Measurement of serum creatinine and eGFR is recommended in all hypertensive patients. 180 I B

Measurement of urine albumin:creatinine ratio is recommended in all hypertensive patients. 43,180 I B
Renal ultrasound and Doppler examination should be considered in patients with impaired renal function, albuminuria, or for
IIa C
suspected secondary hypertension.
Fundoscopy
Is recommended in patients with grades 2 or 3 hypertension and all hypertensive patients with diabetes. I C
May be considered in other hypertensive patients. IIb C
Brain

In hypertensive patients with neurological symptoms and/or cognitive decline, brain MRI or CT should be considered for
168,169 IIa B
detecting brain infarctions, microbleeds, and white matter lesions.

ABI = ankle–brachial index; CT = computed tomography; ECG = electrocardiogram; eGFR = estimated glomerular filtration rate; HMOD = hypertension-mediated organ dam-
age; LEAD = lower extremity arterial disease; LV = left ventricular; LVH = left ventricular hypertrophy; MRI = magnetic resonance imaging; PWV = pulse wave velocity; TIA =
transient ischaemic attack.
a
Class of recommendation.
b
Level of evidence.

.
6 Genetics and hypertension . . . . . monogenic forms of hypertension have been described such as
glucocorticoid-remediable aldosteronism, Liddle’s syndrome, and
A positive family history is a frequent feature in hypertensive . . . . others, where a single gene mutation fully explains the pathogenesis
patients, with the heritability estimated to vary between 35 and . . . of hypertension and dictates the best treatment modality. 194–196
50% in most studies. 191,192 However, hypertension is a highly heter- . . . There are also inherited forms of phaeochromocytoma and para-
ogeneous disorder with a multifactorial aetiology. Several genome- . . . ganglioma, which are also rare causes of hypertension. 197–200
wide association studies and their meta-analyses have identified . . . Outside of specialist clinics evaluating patients for these rare causes
120 loci that are associated with BP regulation, but together these . . . of secondary hypertension, there is no role for genetic testing in
only explain about 3.5% of the trait variance. 193 Several rare, . . . hypertension in routine clinical care.

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