Evaluation of subclinical cardiac damage in arterial hypertension: From guidelines to clinical practice

The increased use of echocardiography and related techniques for both research and clinical purposes is related with the identification of a variety of subclinical cardiac changes in subjects with hypertension, with special relevance of left ventricular hypertrophy (LVH). LVH, assessed by electrocardiography (EKG) or echocardiography, is a strong, independent predictor for cardiovascular events and all-cause mortality in hypertensive individuals. EKG is the standard technique for detecting LVH in patients with hypertension; however, its sensitivity is lower than echocardiography. Echocardiography provides information on cardiac anatomy and function unavailable by any other means with comparable cost-effective profile and is free of any biological risk, but the technique entails a number of technical problems in imaging acquisition and data interpretation (intra- and inter-observer variability, low quality of imaging in obese subjects and in individuals with chronic pulmonary diseases, need for adequate echocardiograms. This manuscript reviews the persistent gap between clinical practice and evidence-based medicine and guidelines for subclinical cardiac damage evaluation.