Cardiac Evaluation and Management for Hypertensive Patients with Horseshoe Kidney

Initial Cardiac Assessment

The European Society of Cardiology recommends a 12-lead ECG as part of the routine initial workup for all patients with hypertension, regardless of age or comorbidities, to assess for left ventricular hypertrophy (LVH) and atrial fibrillation (AF) 1, 2
Basic laboratory tests, including serum creatinine, estimated glomerular filtration rate (eGFR), and urinary albumin-to-creatinine ratio (ACR), should be performed to assess kidney function and hypertension-mediated organ damage (HMOD) 1, 3

Echocardiography is recommended for patients with abnormal ECG findings, cardiac murmurs on physical examination, cardiac symptoms, or signs of hypertensive heart disease 1, 4
The European Heart Society suggests considering echocardiography even with normal ECG if resources and reimbursement policies allow, and if it would likely change patient management 1, 3

Renal ultrasound and Doppler examination should be performed to assess kidney structure, determine causes of potential chronic kidney disease (CKD), and exclude renovascular hypertension 1, 4

For patients under 40 years, screening for HMOD should be considered since standard cardiovascular risk calculators are not validated in this age group 5
Additional cardiac testing, such as coronary artery calcium (CAC) scoring, high-sensitivity cardiac troponin, and/or NT-proBNP, may be considered based on risk assessment to assess for subclinical cardiac damage 1, 2, 4
Carotid or femoral ultrasound may be considered to detect atherosclerotic plaque 6

Cardiac biomarkers should be interpreted with caution in patients with reduced kidney function, as they may be elevated due to decreased renal clearance rather than cardiac damage 7
Regular monitoring of kidney function is essential, with annual measurements of serum creatinine, eGFR, and urine ACR if moderate-to-severe CKD is diagnosed 1, 8
Repeat ECG and consider more comprehensive cardiovascular assessment if hypertension becomes difficult to control or if cardiac symptoms develop 1, 4