title: Impact of carotid intima-media thickening on risk stratification in elderly hypertensives.
abstract: BACKGROUND
  It has been shown that aging and arterial hypertension are both associated with an increased prevalence of carotid structural abnormalities, such as intima-media (IM) thickening or plaques, which are a powerful independent predictor of cardiovascular (CV) events. We investigated the impact of carotid IM thickening in profiling the absolute CV risk stratification according the 1999 World Health Organization/International Society of Hypertension (WHO/ISH) guidelines in elderly hypertensive patients.
  
  
  METHODS
  Two hundred and thirty untreated elderly patients (>65 years) referred to our outpatient hospital clinic were included in the study. They underwent the following procedures: (i) medical history, physical examination and clinic blood pressure measurement; (ii) routine blood chemistry and urine analysis; (iii) electrocardiogram. The risk was initially stratified according to the routine procedures indicated by WHO/ISH guidelines and subsequently reassessed by adding the results of carotid ultrasonography (IM thickening as diffuse IM thickness >0.9 and <1.3 mm).
  
  
  RESULTS
  According to routine classification 56% (=129) were medium-risk patients, 29% (n = 67) high-risk and 15% (n = 34) very-high-risk patients. The overall prevalence of carotid IM thickening was 54% (49% in medium-risk vs 60% in high or very high-risk patients, p < 0.05). A marked change in risk stratification was observed when IM thickening was taken in consideration: medium-risk patients decreased to 29% and high-risk rose to 56% (p < 0.01).
  
  
  CONCLUSIONS
  Ultrasound assessment of large artery damage is extremely useful for a more accurate estimate of global CV risk in elderly hypertensives, because stratification based on diagnostic routine procedures can underestimate the overall risk in a large fraction of medium-risk subjects.
authors.affiliation: Istituto di Clinica, Medica e Terapia Medica and Centro di Fisiologia Clinica e Ipertensione, Università di Milano, Ospedale Maggiore IRCCS, Milano, Italy. dhipertensione@libero.it
authors.forename: Cesare
authors.initials: C
authors.lastname: Cuspidi
authors.forename: Iassen
authors.initials: I
authors.lastname: Michev
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Macca
authors.forename: Stefano
authors.initials: S
authors.lastname: Meani
authors.forename: Maurizio
authors.initials: M
authors.lastname: Salerno
authors.forename: Cristiana
authors.initials: C
authors.lastname: Valerio
authors.forename: Laura
authors.initials: L
authors.lastname: Lonati
authors.forename: Gastone
authors.initials: G
authors.lastname: Leonetti
authors.forename: Fabio
authors.initials: F
authors.lastname: Magrini
authors.forename: Alberto
authors.initials: A
authors.lastname: Zanchetti
mesh_terms: D000367:Age Factors; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D012307:Risk Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology*; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000473:pathology*