Assessment of cardiac status in hypertensive patients.

Evaluation of cardiac participation in hypertension includes much more than determination of the presence or absence of left ventricular hypertrophy by chest X-ray or electrocardiography. Chest X-ray has not proved very useful in the work-up of hypertensive patients in contrast with electrocardiography. Although electrocardiography is highly specific for left ventricular hypertrophy, it is not sensitive enough for many cases nor does it allow functional assessment of cardiac performance. Echocardiography, on the other hand, is a much more powerful tool for the evaluation of both the anatomical and functional aspects of cardiac performance. However, although it cannot be recommended as yet for routine evaluation of all patients, it is rapidly becoming an important examination for many patients. It allows not only quantitative estimate of left ventricular hypertrophy (LVH), but will also determine the distribution of hypertrophy, its effects on both systolic and diastolic functions of the heart and its alteration with therapy. As regards specific tests for myocardial perfusion, coronary reserve and ventricular volume analysis, these techniques are indicated more for clinical research or very special circumstances than for routine use. In summary assessment of cardiac status of a hypertensive patient should include the following: a precise diagnosis of LVH, estimate of cardiac performance, both systolic and diastolic, evaluation of cardiac factors in resistance to antihypertensive therapy and follow-up of regression of structural alterations during antihypertensive treatment.