Hypertensive Cardiovascular Organ Damage

Hypertension leads to development of structural and function changes in the heart and arteries which may be assessed by cardiovascular imaging. These changes are collectively termed hypertension associated organ damage and are in fact the preclinical stages of cardiovascular disease. In the heart, women with hypertension more often develop left ventricular (LV) hypertrophy, concentric LV geometry, left atrial enlargement and LV diastolic dysfunction, while LV ejection fraction most often is normal. LV hypertrophy is less modifiable by antihypertensive drug treatment in women and increases the risk of clinical cardiovascular events relatively more in women than men. Women also more often develop new-onset LV hypertrophy during antihypertensive drug treatment. Large artery stiffness increases steeper with aging in women. Increased arterial stiffness carries a higher risk of cardiovascular events in women than men. Women with hypertension have more positive remodeling and less plaque calcifications in the carotid arteries. Similarly, women have a lower coronary artery calcium (CAC) score by computed tomography. Young women may have extensive coronary artery disease even when the CAC score is zero. Early onset of coronary calcification is found in women who develop hypertension early in life due to autoimmune disorders or a history of preeclampsia. Taken together, use of multimodality cardiovascular imaging and sex specific reference values are needed for accurate identification of cardiovascular organ damage in women.