title: Change in cardiovascular risk profile by echocardiography in low- or medium-risk hypertension.
abstract: BACKGROUND
  Clinical decision-making in hypertensive patients is largely based upon assessment of total cardiovascular risk. World Health Organization-International Society of Hypertension (WHO-ISH) guidelines suggest delaying or withholding drug treatment in individuals assessed as at low risk on the basis of a suggested work-up that does not include echocardiography.
  
  
  OBJECTIVE
  To assess the impact of echocardiography on risk stratification in never-treated individuals classified as at low cardiovascular risk.
  
  
  METHODS
  A retrospective analysis of a prospective survey.
  
  
  METHODS
  Outpatient hypertension clinics of three community hospitals.
  
  
  METHODS
  A total of 792 hypertensive adults classified as at low or medium risk, drawn from a larger sample of 1322 never-treated hypertensive patients.
  
  
  METHODS
  Change in risk class and need of immediate treatment after echocardiographic evaluation of left ventricular hypertrophy.
  
  
  RESULTS
  Those at low and medium risk according to WHO-ISH (to receive delayed treatment) represented 17 and 43%, respectively, of the whole hypertensive population. The prevalence of left ventricular hypertrophy on echocardiography was 21 and 32% in low- and medium-risk groups, respectively (29% on average).
  
  
  CONCLUSIONS
  In untreated hypertensive individuals without overt target-organ damage, in whom treatment would be postponed or avoided according to current WHO-ISH guidelines, echocardiography modifies the risk classification in 29% of the cases, identifying a need for immediate drug treatment. In low-risk untreated hypertensive individuals, echocardiography commonly alters risk stratification based on the initial WHO-ISH work-up.
authors.affiliation: Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy. skill@unipg.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Schillaci
authors.forename: Giovanni
authors.initials: G
authors.lastname: De Simone
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Reboldi
authors.forename: Carlo
authors.initials: C
authors.lastname: Porcellati
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Paolo
authors.initials: P
authors.lastname: Verdecchia
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000145:classification / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014944:World Health Organization