Appendix B: Screening Tests for End Organ Damage Due to Hypertension - Public Safety Medicine

Cardiovascular Disease: Hypertension

sec_arr Appendix B: Screening Tests for End Organ Damage Due to Hypertension
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Appendix B: Screening Tests for End-Organ Damage Due to Hypertension

 Kidneys7, 14

  • Spot serum creatinine to estimate the glomerular filtration rate using the 2009 CKD-EPI or MDRD calculation method and
  • Spot urine albumin to creatinine ratio

 Chronic kidney disease (one type of end organ damage) is diagnosed if, over a period of 3 months, the PSW has either of the following:7, 14

  • an estimated glomerular filtration rate <60 mL/min/1.73m19; OR
  • a urine albumin to creatinine ratio of >30 mg/g.

Chronic kidney disease is associated with increased rates of both fatal and non-fatal cardiovascular events.7, 8, 10-12, 17 This CVD risk is a graded association; the more severe the kidney disease, the higher the CVD risk.12 For patients with mild to moderate chronic kidney disease (an estimated glomerular filtration rate between 45-60 mL/min/1.73m2), the CVD risk is 20% higher than those with an estimated glomerular filtration rate >60 mL/min/1.73m2.12 The TG considers the CVD risk of a PSW with chronic kidney disease, even those with mild to moderate chronic kidney disease, to warrant a symptom-limiting exercise stress test.

Cardiovascular

  • Symptoms (e.g. dyspnea, fatigue) or signs (e.g. fluid retention, reduced left ventricular ejection fraction) of heart failure.
  • Tests for left ventricular hypertrophy (LVH). While an electrocardiogram (ECG) can detect LVH, echocardiography or cardiac magnetic resonance imaging (MRI) are more sensitive tools.16
  • Symptoms consistent with transient ischemic attacks (TIAs).
  • Heart failure, LVH, coronary artery disease, cerebrovascular disease, peripheral artery disease are all complications (end organ damage) of chronic hypertension.18 All three are associated with an increased risk of fatal and non-fatal cardiovascular events. PSW with any of these cardiovascular complications of hypertension warrants a symptom-limited imaging EST.

Ophthalmologic

Dilated eye examinations or retinal scan for retinopathy.
For the purposes of this document, Grade 3 or higher retinopathy (using the Modified Scheie Classification of Hypertensive Retinopathy) is considered positive for end-organ damage and is associated with increased cardiovascular risk.6, 13