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Echocardiography in Hypertension in the Era of Risk Stratification and Personalized Medicine.

Echocardiography is commonly performed in the initial work-up of hypertensive patients and during follow-up. According to 2013 ESH/ESC guidelines, the only echocardiography parameter considered for total cardiovascular (CV) risk stratification is left ventricular (LV) hypertrophy, defined as a LV mass index >115 g/m 2 in men and >95 g/m 2 in women. 1 The guidelines recommend that “echocardiog-raphy should be considered to refine CV risk and confirm electrocardiogram diagnosis of LV hypertrophy, left atrial dilatation or suspected concomitant heart disease, when these are suspected” (IIa, level of evidence B). The Eighth Joint National Committee guideline does not recommend the use of echocardiography, whereas the Seventh Joint National Committee only mentions echocardiography to detect LV hypertrophy. Overall, evidence to support the wide use of echocardiography as a risk stratifier in hypertension is insufficient. provide relevant information, and E / E ′ derived from this strain rate method has already been proven to yield more accurate es- timates of invasive wedge pressures. Consequently, early diastolic global LV longitudinal strain rate could be much more closely associated with outcome in hypertensive patients than classical diastolic function variables. (4) Left atrial (LA) remodeling and function has been recently emphasized as a very strong predictor of outcome in patients with heart failure. 13 In a population mainly composed of hypertensive patients, LA volume is a better prognostic variable than LA surface or diameter. 14 We suggest that LA ejection fraction and LA strain is the next LA-based variable that could further refine echocardiography-based risk stratification in hypertensive patients.