Selecting the optimal method for assessment of hypertension-mediated organ damage: a personalized approach

AIMS: Susceptibility to hypertension-mediated organ damage (HMOD) is influenced by genetics, age, gender, and additional cardiovascular risk factors and comorbidities in the individual patient. All major hypertension guidelines recommend assessment of HMOD to identify high cardiovascular risk. However, in clinical practice, it may be difficult to choose the optimal strategy and diagnostic tools for the individual patient. METHODS AND RESULTS: We reviewed recommendations on HMOD assessment in the 2024 European Society of Cardiology, the 2023 European Society of Hypertension, the 2025 American Heart Association/American College of Cardiology, and the 2020 International Society of Hypertension guidelines to provide an expert opinion on how to optimize the diagnosis of HMOD in clinical practice. Basic assessment of cardiac and renal HMOD is recommended in all patients using electrocardiography, serum creatinine, and estimated glomerular filtration rate, and albumin-creatinine ratio in a morning spot-urine. Advanced tests for HMOD assessment are indicated depending on findings at the initial clinical assessment, whether results are likely to change management, and local availability and resources. Echocardiography remains the preferred initial test and may add prognostic information in most patients. Identification of premature atherosclerosis by ultrasound or coronary artery calcium score or arterial stiffness by pulse wave velocity may be indicated in young and middle-aged individuals with arterial hypertension or blood pressure close to treatment threshold, if likely to change management. CONCLUSION: HMOD is a marker of high cardiovascular risk. Basic assessment should be performed in all patients with arterial hypertension, and more advanced tests in selected patients. LAY SUMMARY: High blood pressure (hypertension) leads to damage of the heart, arteries, eyes, brain, and kidneys, collectively termed hypertension-mediated organ damage (HMOD). Presence of HMOD is associated with a 2-3-fold increased risk of subsequent cardiovascular disease. The hypertension guidelines, therefore, recommend looking for HMOD in the evaluation of patients with hypertension to identify high-risk individuals. To help clinicians make informed decisions on what type of test to choose for HMOD assessment, we have compared the recommendations of the most important recently issued hypertension guidelines.Key findings are:Basic HMOD screening of heart and kidney function should be performed in all individuals with hypertension, including taking an electrocardiogram and blood and urine tests to evaluate kidney function.Targeted advanced HMOD assessment in specialized health care is recommended in selected individuals based on findings in the initial evaluation. This may include ultrasound examination of the heart, kidneys or arteries, measurement of arterial stiffness or imaging of the heart, brain or arteries by computed tomography or magnetic resonance imaging.