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Spectral Doppler ultrasonography provides the evaluation of renal resistive index (RRI), a noninvasive and reproducible measure to investigate arterial compliance and/or resistance. RRI seems to possess an important role in the evaluation of diverse cases of secondary hypertension. In essential hypertension, RRI is associated with subclinical markers of target organ damage and reflects renal disease progression beyond albuminuria and creatinine clearance. Also, RRI can estimate cardiovascular and renal risk. The evaluation of RRI may also help the therapeutic decisions. Given its simple assessment, RRI emerges as a simple method and a “multifunctional” tool that could help on the cardiovascular risk evaluation of the hypertensive patient.

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It is well known that atrial fibrillation (AF) is the most frequent cardiac arrhythmia worldwide and substantially increases the risk for thromboembolic disease. One of the main problems is that it remains undiagnosed (about 20% of all cases of AF). On the other hand, hypertension amplifies the risk for both AF occurrences through hemodynamic and non-hemodynamic mechanisms and cerebrovascular ischemia. Under this prism, prompt diagnosis of undetected AF in hypertensive patients is of pivotal importance. Biomarkers could be used in AF diagnosis as well as in predicting the transition of paroxysmal AF to sustained AF. Last year's many biomarkers has been developed and they can categorized into electrophysiological, morphological, and molecular markers that reflect the underlying mechanisms of adverse atrial remodeling that constitutes the hallmark of this arrhythmia. In this review study, we focused on P-wave duration and dispersion as electrophysiological markers of AF and left atrial (LA) and LA appendage size, atrial fibrosis, left ventricular hypertrophy, aortic stiffness and connexins as structural biomarkers, respectively. The heterogeneous group of molecular biomarkers of AF encompasses products of the neurohormonal cascade, including. NT-pro BNP, BNP, MR-pro ANP, polymorphisms of the ACE and convertases such as corin and furin that are implemented in BNP modulation. In addition, soluble biomarkers of inflammation (i.e. CRP, IL-6) and fibrosis (i.e. TGF-1 and matrix metalloproteinases) were assessed for predicting AF. The reviewed individual biomarkers should add to current diagnostic tools but the ideal candidate is expected to combine multiple indices of atrial remodeling in order to effectively detect both AF and adverse characteristics of high risk hypertensive patients.

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In a well treated hypertensive population, patients with RHTN show more pronounced renal and cardiac haemodynamic dysfunction compared with patients with controlled HTN. A greater RRI seems to be associated with RHTN and may help identify such patients.