Echocardiography in Hypertension

• In patients with mid-diastolic HTN (90–94 mmHg) with no other cardiovascular risk factors or evidence of endorgan damage (including lack of or equivocal signs of the left ventricular hypertrophy [LVH] on electrocardiography [ECG]) • The demonstration of LVH by echo is generally an indication for medical therapy, while non-pharmacological modalities alone can be used if the left ventricle (LV) mass is normal • In patients who have no evidence of end-organ damage, who have either severe or refractory HTN or HTN that is present in the doctor’s office, but not at home or work. The absence of LVH in this setting suggests either HTN of recent onset or white coat HTN. The presence of the latter can be confirmed by ambulatory blood pressure (BP) monitoring • Similarly, the presence of significant LVH on echocardiography, with normal clinical BP recordings, mandates ambulatory BP monitoring, to detect masked HTN • In patients with known or suspected concomitant heart disease in whom the heart disease itself needs further evaluation or in whom the type of heart disease might suggest a particular form of antihypertensive therapy. As an example, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker would be preferred in a patient with systolic dysfunction or mitral regurgitation • In patients who have a bundle branch block on ECG. In contrast, performance of an echocardiography for the purpose of measuring LV mass is not recommended for the selection of antihypertensive therapy or for the assessment of LV mass in patients without adequate BP control.[1] The European Society of Cardiology HTN guidelines in 2013 mention echocardiography as the second approach after routine history, clinical examination, and laboratory tests. Echocardiography detects LVH, left atrial (LA) dilatation, or associated heart diseases (Class IIb). Canadian HTN Education Programme in 2014 suggested echo evaluation in selected patients with HTN. Echo is not routinely indicated in all hypertensive patients [Table 1 and Figure 2]. If cardiac failure or coronary disease is suspected clinically, LV mass, systolic and diastolic function should be assessed by echo.[2] Abstract