Cardiovascular Disease: Hypertension & Coronary Artery Disease

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

Kidneys9,10 

  • 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 LEO has either of the following9,10:

  • an estimated glomerular filtration rate <60 mL/min/1.73m2; 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.9-16 This CVD risk is a graded association; the more severe the kidney disease, the higher the CVD risk.16 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/1.73m2.16 The TG considers the CVD risk of an LEO 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, reduce 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.5
  • Symptoms consistent with transient ischemic attacks (TIAs).
  • Heart failure, LVH, or TIAs are all complications (end organ damage) of chronic hypertension. All three are associated with an increased risk of fatal and non-fatal cardiovascular events. LEO with any of these cardiovascular complications of hypertension warrant a symptom-limiting exercise stress test.

Ophthalmologic

Dilated eye examinations 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.8,17