An aortic aneurysm is a localized dilatation of the aorta greater than 50% the normal diameter and it should include the three layers of the wall. One of the main causes includes hypertension. Echocardiography is a very useful diagnostic tool for aortic aneurysm assessment. Transthoracic echocardiography TTE is the first- choice diagnostic tool for this indication and trans-oesophageal echocardiography (TOE) is used if additional information is required.

The aim or our study is to analyze the profile of our severe hypertensive patients (pts) who develop discomfort with often migrating chest pain.

We performed a prospective study starting from October 2010 to 2015, on 62 consecutive hypertensive patients mean age 64±14 years, 87% male. They underwent clinical, ECG, TTE and TOE examination for assessment of aortic aneurysm. If dissection is present, the De Bakey classification is used: type I if it involves the entire aorta; type II dissection if it involves the ascending aorta and type III if it involves the descending aorta.

26pts (42 %) have association of hypertension, diabetes mellitus tobacco smoking; 30pts have the combination of hypertension-dyslipidaemia and tobacco smoking, mean BMI 29kg/m², SBP/DBP 169/91mmHg. Six pts (10%) presents an abdominal aneurysm; 24pts (38%) aneurysm of the ascending aorta; type III dissection in 18pts (29%); dissection type II in 7pts (11%) who underwent Bentall procedure and in 8 (13%) pts the entire aorta is involved, type I dissection from the De Bakey classification. All the patients didn't reach the Blood pressure goal.

To decrease the frequency of this stressful environment in critically ill patients but especially to reduce mortality and morbidity, we insist on the primary prevention against uncontrolled hypertension, the fight again obesity, diabetes and tobacco addiction.