Subclinical Hypertension-Mediated Organ Damage (HMOD) in Hypertension: Atherosclerotic Cardiovascular Disease (ASCVD) and Calcium Score

Abstract

Calcium controls numerous events within the vessel wall. Permeability of the endothelium is calcium dependent, as are platelet activation and adhesion, vascular smooth muscle proliferation and migration, and synthesis of fibrous connective tissue. Double-helix computerized tomography is a noninvasive technique that can detect, measure, and compare coronary calcification in the coronary arteries. Despite some convincing evidence about the prognostic value and usefulness of coronary artery calcium score (CACS) in the stratification of cardiovascular risk in the high risk general population and also in hypertensive patients, current guidelines for the management of hypertension, do not include such evaluation among the recommended procedures to be performed in the majority of patients even with the intent to detect hypertension-mediated organ damage (HMOD) in an early phase. On the contrary, the European Society of Cardiology guidelines for the diagnosis and management of chronic coronary syndromes, the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease, and the 2018 Cholesterol Clinical Practice Guidelines indicate that the evaluation of CACS may be of some usefulness in specific subpopulations, although this view is not accepted in the US Preventive Services Task Force document. Very recently, the European Society of Cardiology Guidelines on cardiovascular disease prevention in clinical practice stated that CACS estimation may be considered to improve risk classification around treatment decision thresholds. In conclusion, the use of CACS as a diagnostic tool is still controversial. While some evidence exists about is ability to improve stratification of cardiovascular risk in primary prevention, in particular in selected patients who are at intermediate or borderline risk of atherosclerotic cardiovascular disease, there is insufficient evidence to use it as a standard means to assess HMOD.

Updates in the management of hypertension

“…The mechanisms underlying the pathophysiology of hypertension represent the infrastructure of the onset of several diseases. Endothelial dysfunction constitutes the first step of atherosclerosis genesis 40 . The ESH has summed up the organs affected by this chronic disease.…”

Aldehyde dehydrogenase 2 rs671 a/A Genotype is Associated with an Increased Risk of Early Onset Coronary Artery Stenosis

“… 1 Atherosclerosis refers to the deposition of lipid and complex carbohydrate substances in the intima of the arteries, accompanied by the proliferation of fiber tissue and the deposition of calcium salts, which can lead to a large class of cardiovascular diseases. 2 , 3 Atherosclerotic cardiovascular diseases (ASCVD) include acute coronary syndrome (ACS), myocardial infarction (MI), stable or unstable angina pectoris, ischemic stroke, transient ischemic attack (TIA), and peripheral artery disease (PAD), which increase the risk for cardiovascular events. 4 Atherosclerosis can lead to artery stenosis.…”

Plasma Biomarkers for Hypertension-Mediated Organ Damage Detection: A Narrative Review

“…As of 2019, deaths caused by hypertension accounted for nearly 20% of all deaths worldwide [5]. Such high burden of cardiovascular morbidity/mortality can be preceded by HMOD, including structural and functional changes in major organs such as heart, brain, kidneys, blood vessels, and retinae, representing preclinical or asymptomatic cardiovascular diseases (CVD) [6]. As HMOD proceeds CVD, screening for HMOD is essential in clinical practice for a more comprehensive and dynamic cardiovascular risk assessment of hypertensive patients.…”