michigan hypertension core curriculum - State of Michigan

sister, mother and father. A family history of coronary events is premature if
occurring in females less than 65 or males less than 55 years of age.
Central weight gain: Waist circumference of 40 inches or greater in a male and 36 inches or greater in
a female.
Heart
Brain
Left Ventricular Hypertrophy
Heart Failure
Angina
Prior myocardial infarction
Prior coronary revascularization
Stroke
Transient Ischemic Attack
Dementia
CKD
Peripheral Artery Disease
Retinopathy
158 Hypertension Core Curriculum
Evaluation for Target-organ Damage
Hypertensive Heart Disease (HHD), Left Ventricular Hypertrophy (LVH) and Congestive
Heart Failure (CHF)
Hypertensive heart disease represents the accumulation of a lifetime of longterm
functional and structural adaptations to the increased BP load. 10 Left ventricular
hypertrophy (LVH), an increase in left ventricular (LV) wall thickness and mass, is
associated directly with the level of BP, age, and body size. Elevated SBP and body size
are major contributors to increased left ventricular mass/LVH. 11
The prevalence of LVH is difficult to assess and depends on the method and
criteria used. Echocardiography is more sensitive than ECG, but is also more expensive
and labor intensive. LVH prevalence among hypertensive patients ranges from 20 to
60%. 10,11 As with other forms of target organ damage, LVH is more prevalent in African
Americans and older patients. LVH is an independent risk factor for stroke, myocardial
infarction, sudden death and heart failure. 10
Heart failure is the final phase of hypertensive heart disease and involves the
progression from hypertension to diastolic dysfunction with preserved systolic function
and ultimately to ventricular dilatation and systolic cardiac dysfunction/failure. 2,3
Angina, myocardial infarction, prior coronary revascularization
Obtain a history of prior revasularization(s) and/or other vascular procedures,
myocardial infarction, chest pain typical for angina, type and outcomes of stress testing,
and peripheral vascular disease. 12
Stroke, TIA and Dementia
The risk of ischemic stroke, hemorrhagic stroke, and dementia all increase at
higher levels BP. 2 Patients should be screened for a past history, symptoms or signs
of stroke. Vascular bruits should be noted. If clinically suspected, a mini-mental exam
should be performed to screen for dementia. Successful treatment of BP lowers the risk
of subsequent strokes and slows progression of dementia. 5
Chronic Kidney Disease