Echocardiographic imaging in hypertensive and diabetic patients.

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One of the most common complications of hypertension and diabetes is left ventricular hypertrophy (LVH). Current guidelines indicate that a diagnosis of LVH is associated with allocating the patient to at least a high cardiovascular risk category. LVH is a significant risk factor for cardiovascular events. It has been shown that there is a linear relationship between left ventricular mass index and the risk of developing cardiovascular disease and death from cardiovascular causes and from any cause. One of the sequelae of LVH in patients with hypertension or diabetes of increasing importance due to the aging population and prevalence is heart failure, especially heart failure with preserved ejection fraction (HFpEF). Regression of LVH in the course of antihypertensive treatment is associated with a reduction in cardiovascular risk. A reduction in the rate of cardiovascular events has been demonstrated in hypertensive patients with regression of echocardiographically assessed LVH in the course of hypotensive treatment. In both hypertensive and diabetic patients, the relationship between LVH, impaired diastolic function and consequently to the development of HFpEF is important. One study showed that in 64% of patients with HFpEF, hypertension was responsible for its development. It is important to emphasize the importance of early echocardiographic changes in patients with hypertension or diabetes mellitus, which are seen in the early stages of these diseases. These include left ventricular wall thickening, increased left ventricular mass index, increased E/e’ ratio and left atrial enlargement. This indicates the need for early diagnosis and effective therapy of hypertension and diabetes. New information, also of prognostic importance, is provided by the assessment of systolic function (longitudinal, circumferential, and radial strain) by means of speckle tracking echocardiography. It allows early detection of impaired systolic function in patients whose ejection fraction remains in the normal range. Global longitudinal strain has been shown to correlate linearly with cardiovascular risk. It is also a marker for the development of HFpEF. In conclusion, it should be emphasized that echocardiographic evaluation is an important element in the stratification of cardiovascular risk and also the effectiveness of therapy in patients with hypertension or diabetes. Detection of infrequent early changes prompts intensification of therapy - both lifestyle modification and pharmacological treatment. The wider availability of echocardiography and the assessment of parameters with a proven independent relationship to cardiovascular risk are the basis not only of clinical research but also of everyday clinical practice.