title: Can echocardiography identify mildly hypertensive patients at high risk, left untreated based on current guidelines?
abstract: OBJECTIVE
  To determine whether the decision to treat uncomplicated mild hypertension with drugs, in accordance with the World Health Organization - International Society of Hypertension (WHO/ISH) guidelines based on a series of blood pressure (BP) measurements over 6 months, resulted in the treatment of patients at high risk on the basis of echocardiography.
  
  
  METHODS
  One hundred and eighteen patients with mild hypertension (diastolic blood pressure 90-105 mm Hg and/or systolic blood pressure 140-180 mm Hg) were examined by echocardiography at inclusion and followed up for 6 months by a single physician unaware of the echographic results.
  
  
  RESULTS
  Drug treatment was given to 48 patients, and 70 remained untreated. Treated patients had higher echographic indices than untreated patients (all P<0.05): left ventricular (LV) mass/body surface area (83.0+/-15.6 versus 75.3+/-14.8 g/m2), inter-ventricular septal thickness (9.7+/-1.7 versus 8.5+/-1.3 mm), LV posterior wall thickness (8.4+/-1.1 versus 7.8+/-1.1 mm), relative wall thickness (0.37+/-0.06 versus 0.34+/-0.06). LV geometry was normal in 98 patients, and 20 had LV concentric remodelling. The 10-year coronary disease risk (Framingham equation) was higher in the 20 patients with concentric remodelling than in those with normal LV geometry (10.4 versus 4.2%; P<0.005). Nine of these 20 patients were still untreated at the end of the 6-month follow-up period.
  
  
  CONCLUSIONS
  Rigorous application of the WHO/ISH clinical guidelines in a group of mild hypertensive patients led to the treatment of patients with slightly higher LV mass and more concentric LV geometry than were found in those not treated. However, a high-risk subgroup, with concentric remodelling, was not identified and left untreated.
authors.affiliation: Centre d'Investigations Cliniques, Paris, France. eric.abergel@brs.ap-hop-paris.fr
authors.forename: E
authors.initials: E
authors.lastname: Abergel
authors.forename: G
authors.initials: G
authors.lastname: Chatellier
authors.forename: C
authors.initials: C
authors.lastname: Battaglia
authors.forename: J
authors.initials: J
authors.lastname: Menard
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012955:Societies, Medical; D020257:Ventricular Remodeling; D014944:World Health Organization
chemical_list: D000959:Antihypertensive Agents