Table 10. Assessment of hypertension-mediated organ damage.

Organ	HMOD	Screening test	Indication and interpretation
Brain	Stroke (ischemia/hemorrhage)	Brain imaging	To detect brain infarction, microbleeds and white matter lesions in hypertensive patients with neurological symptoms.
	Transient ischemic attack		Early subclinical changes can be identified by MRI with the highest sensitivity, but routine MRI is not recommended due to costs, and should be evaluated by a specialist.
	Cognitive impairment
		Cognitive function testing	To assess cognition in hypertensive patients with symptoms suggestive of cognitive decline.
Eyes	Hypertensive retinopathy	Fundoscopy or fundus camera	To detect hypertensive retinopathy (retinal changes, hemorrhages, microaneurysms, hard exudates, cotton wool spots, papilledema, tortuosity and nipping), especially in hypertensive urgencies and emergencies.
Heart	LVH	ECG	To screen for LVH, atrial fibrillation, ischemic heart disease and other possible abnormalities, and to record baseline heart rate and rhythm.
	Atrial fibrillation		The sensitivity of ECG is limited and requires further echocardiography to confirm the diagnosis.
	Heart failure
		Echocardiography	To evaluate cardiac structure and function (ventricular geometry, systolic and diastolic function, left atrial size, aortic root dimensions and subclinical systolic function impairment assessed by myocardial strain).
Kidney	Chronic kidney disease	eGFR	To evaluate kidney function and detect renal disease.
	Proteinuria/albuminuria
		Proteinuria	To assess albumin excretion in possible renal disease, the most commonly used tool is UACR in early morning spot urine.
Blood vessels	Carotid atherosclerosis	Carotid ultrasound	To determine the carotid plaque burden (atherosclerosis), stenosis and IMT, especially in hypertensive patients with cerebrovascular disease.
	Aortic stiffness
	Aortic aneurysm
	Peripheral artery disease
		Abdominal ultrasound	Evaluate abdominal aorta for the presence of aneurysmal dilatation and vascular disease.
			To evaluate renal size and structure in patients with chronic kidney disease. In addition, renal artery Doppler echo may help to screen for the presence of renovascular disease.
		ABI	To screen for peripheral arterial obstructive disease (lower extremities).
		PWV	To evaluate the degree of arterial stiffness.

ABI, ankle brachial index; ECG, electrocardiogram; eGFR, estimated glomerular filtration rate; HMOD, hypertension-mediated organ damage; IMT, intima media thickness; LVH, left ventricular hypertrophy; MRI, magnetic resonance imaging; PWV, pulse wave velocity; UACR, urinary albumin-creatinine ratio.