Background: End organ damage in hypertension can be detected early, reflects accurately the hypertensive patient's overall cardiovascular risk, and should be prevented and treated with antihypertensive treatment.
Method: We selectively review the relevant literature since 1995, including the German and European guidelines for the diagnosis and treatment of arterial hypertension.
Results: Measurement of the intima-media thickness in the common carotid artery and of the pulse-wave velocity is now recommended for the early diagnosis of hypertensive vasculopathy. Left ventricular hypertrophy, an important component of hypertensive heart disease, can be diagnosed by echocardiography and with the aid of new electrocardiographic indices. Early signs of hypertensive nephropathy, namely albuminuria and a decreased glomerular filtration rate, are prognostically valuable and easy to detect. Cerebrovascular damage, including early microangiopathic changes, is best diagnosed by magnetic resonance imaging. The treatment of end organ damage due to hypertension centers on blood pressure reduction. Blockade of the renin angiotensin-aldosterone system is an essential part of the treatment of early end organ damage.
Conclusion: Hypertensive end organ damage can now be diagnosed early and reversed with specific and aggressive treatment.