Change in cardiovascular risk profile by echocardiography in low- or medium-risk hypertension.
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.
Schillaci
Giuseppe
G
Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy. skill@unipg.it
De Simone
Giovanni
G
Reboldi
Gianpaolo
G
Porcellati
Carlo
C
Devereux
Richard B
RB
Verdecchia
Paolo
P
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