Overview
Hypertensive target organ damage refers to the pathologic damage of heart, brain, kidney, blood vessels and other organs caused by or accompanied by hypertension, which can be categorized into functional and structural damage, acute or chronic damage, subclinical target organ damage or clinical complications. In the prevention and treatment of hypertension, special attention should be paid to the early detection of subclinical target organ damage, and the diagnosis relies on laboratory and imaging examinations, etc. Prevention and timely treatment of early damage can significantly improve the quality of patient’s survival and increase the success rate of treatment, and the correct selection of anti-hypertensive drugs is also one of the main methods to prevent and reduce hypertensive target organ damage.
Etiology
Chronically elevated arterial blood pressure increases the pressure load on target organs; hypertension triggers vascular remodeling and endothelial function abnormality, which directly affects the perfusion of the heart, brain, kidney and other organs; elevated blood pressure can also cause excessive activation of sympathetic nerves and renin-angiotensin system, metabolic abnormality and inflammatory response, and these non-hemodynamic changes will aggravate and accelerate target organ damage.
Symptoms
In addition to the persistent elevation of arterial blood pressure, different target organ damage will have different clinical manifestations.
1. Cardiac damage
It can be manifested as left ventricular hypertrophy, left ventricular systolic and diastolic function abnormalities, chronic heart failure, angina pectoris, myocardial infarction, etc.
2. Brain damage
It can be manifested as transient ischemic attack, cerebral hemorrhage, hypertensive encephalopathy, cognitive function reduction, dementia, loss of vision and so on.
3. Kidney damage
Microalbuminuria and proteinuria, chronic kidney disease, end-stage renal disease, etc. can occur.
4. Vascular damage
It can be manifested as endothelial function abnormality, carotid artery intima-media thickening, atheromatous plaque formation, aortic coarctation and so on.
5. Retinal damage
It can be manifested as hemorrhage, exudation or optic disc edema.
6. Others
Hypertension can also cause hearing damage.
Examination
1. Laboratory examination
Routine tests include routine blood test, routine urine test, blood biochemistry and so on.
2. Electrocardiogram
It is useful in determining heart disease such as myocardial infarction and angina pectoris.
3. Imaging examination
Cardiac ultrasound, coronary artery CT, head CT, magnetic resonance imaging, abdominal color Doppler ultrasound, funduscopic examination and so on can help to understand the damage of target organs.
Diagnosis
Diagnosis is made on the basis of a history of hypertension combined with the clinical manifestations of the target organ, laboratory tests and other findings.
Treatment
The principle of treatment is to control the blood pressure and cardiovascular risk factors, protect the target organs, and individualize the treatment with small dose, long duration, and combination of drugs.
1. Heart damage
Patients with heart failure should be treated with diuretics first, and angiotensin-converting enzyme inhibitors (or angiotensin II receptor blockers) and β-receptor antagonists should be preferred. Patients with coronary atherosclerotic heart disease (coronary heart disease) should be given priority to β-receptor antagonists and calcium channel blockers, and angiotensin-converting enzyme inhibitors can also be used.
2. Brain damage
Pay attention to the prevention and treatment of cerebral edema and intracranial pressure increase, and carry out surgical treatment if necessary.
3. Kidney damage
When renal damage occurs, the preferred drugs are angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and calcium channel blockers.
4. Retinal damage
For retinopathy, if the blood pressure rises sharply, it is better to make the diastolic blood pressure fall slowly and steadily, and a sharp drop in blood pressure may cause organ ischemia.
5. Other
Select the appropriate treatment according to the damaged target organ, severity and patient’s condition.