Echocardiography for primary care evaluation of hypertension.

OBJECTIVE: To reexamine the changing role of echocardiography for primary care evaluation of essential hypertension since the 1993 Canadian Hypertension Society Consensus Conference. QUALITY OF EVIDENCE: New recommendations from the Canadian Cardiovascular Society and the Canadian Hypertension Society. Recommendations from the American College of Cardiology based on a prospective, randomized controlled trial of limited echocardiograms. Further results from the Framingham Heart Study and the Treatment of Mild Hypertension Study. MAIN MESSAGE: For patients with essential hypertension, left ventricular hypertrophy (LVH) continues to be a strong predictor of many cardiovascular end points, and echocardiography is a much more sensitive tool for detecting LVH than electrocardiogram (ECG). Although limited echocardiograms are not usually used, they are a less costly method of evaluating LVH than standard echocardiograms and have recently been recommended in the United States to assist in the decision to initiate pharmacotherapy for patients with stage 1 hypertension and no other evidence of target organ damage. Problems with intrareader and interreader variability of results are being addressed by technical and mathematical standards established by the Canadian Cardiovascular Society and the Canadian Hypertension Society.
CONCLUSIONS: Using limited echocardiograms for assessing LVH coupled with implementing Canadian technical standards might lead to a greater role for echocardiography in evaluating essential hypertension in certain patients.