Pre-clinical detection of cardiac dysfunction and coronary artery disease in essential hypertension: An update

Systemic hypertension (HTN) is a syndrome and it can induce other diseases and biochemical abnormalities, including stroke, coronary artery disease, heart failure (HF), obesity, kidney failure, glucose intolerance, dyslipidemia and even death. Epidemiological researches have established that HTN is a powerful contributor to major cardiovascular diseases. Hypertension is the single most important preventable cause of premature death in the Western world estimating at 20% of adult population. The quest to find effective treatment, both in terms of blood pressure control and prevention, such as heart attacks and strokes are still on-going. Although clinicians favor the diagnosis and treatment of hypertension in terms of diastolic blood pressure elevation and categorical cut of points, epidemiological data show important influence of systolic blood pressure and associated risk factors that contribute to atherosclerosis predicting clinical HF. Early detection of subclinical myocardial disease among hypertensive population is a holy grail of all cardiologists, but difficult when using the conventional echocardiography (CE). By comparison to CE, speckle tracking echocardiography (STE) is more specific obtaining longitudinal and circumferential strain, which are able to identify sub clinical myocardial abnormalities with a higher degree of accuracy. This review described the epidemiology of hypertension relating it to cardiovascular events including preclinical detection of cardiac dysfunction in HTN explaining how this could be detected by STE and other imaging modalities. These changes provide new targets for preclinical diagnosis monitoring responses to preventive strategies.