Arterial Hypertension and Cardiovascular Risk

Abstract

Estimation of total cardiovascular risk is essential for guiding management of hypertension. Computerized methods have been developed for estimating total cardiovascular risk (i.e., the likelihood of developing a cardiovascular event, usually within the next 10 years), most of which are based either on the Framingham risk score or the European SCORE (Systemic Coronary Risk Evaluation) project. The 2013 ESH-ESC guidelines suggest subclinical organ damage as an integral part of the risk stratification and evaluation of hypertensive patients. Subclinical organ damage is considered an intermediate stage in the continuum of vascular disease and a determinant of overall cardiovascular risk. Search for subclinical organ damage should be performed carefully using appropriate techniques depending on the availability and resources. Electrocardiography and evaluation of urinary albumin excretion should be part of routine assessment of hypertensive patients. Subclinical organ damage should be also measured during treatment because there is evidence that regression of left ventricular hypertrophy and reduction of proteinuria are associated with improved prognosis. Search for subclinical organ damage should be made simultaneously in various organs because multiorgan subclinical damage is associated with a worse prognosis.