Baseline Echocardiography and Stress Testing in Hypertension

Rationale for Baseline Echocardiography

The European Association of Cardiovascular Imaging recommends echocardiography for cardiovascular risk assessment in adults with hypertension, with a Class II indication (level of evidence B) 2
Echocardiography is appropriate for hypertensive patients with suspected hypertensive cardiac disease or cardiac disease in association with comorbidities, such as dyskinesia 1
The European Heart Journal guidelines suggest that echocardiography can identify critical prognostic markers, including left ventricular hypertrophy, diastolic dysfunction, and left atrial enlargement, which predict cardiovascular events 2

The European Heart Journal guidelines state that stress testing is not routinely recommended for asymptomatic hypertensive patients, due to the risk of false-positive results and uncertain management responses 2
Screening for coronary disease is not recommended in asymptomatic hypertensive patients, and routine stress testing is characterized as "rarely appropriate" with a value score of 3 out of 10 4, 1
Stress testing may be indicated if the patient has chest pain symptoms, with stress echocardiography preferred over perfusion imaging due to its high specificity for coronary artery disease 5, 2

The European Association of Cardiovascular Imaging recommends optimizing therapy with agents that promote LVH regression (ACE inhibitors, ARBs, or diuretics) if LV hypertrophy is detected 3
Detection of cardiac abnormalities justifies more aggressive BP targets (<130/80 mmHg), according to the European Heart Journal guidelines 3