title: Should we perform an echocardiogram in hypertensive patients classified as having low and medium risk?
abstract: BACKGROUND
  Left ventricular hypertrophy is an important predictor of cardiovascular risk and its detection contributes to risk stratification. However, echocardiography is not a routine procedure and electrocardiography (ECG) underestimates its prevalence.
  
  
  OBJECTIVE
  To evaluate the prevalence of echocardiographic left ventricular hypertrophy in low and medium risk non-treated hypertensive subjects, in order to find out the percentage of them who would be reclassified as high risk patients.
  
  
  METHODS
  Cross-sectional, multicenter study was performed in hospital located hypertension units. An echocardiogram was performed in 197 previously untreated hypertensive patients, > 18 years, classified as having low (61%) or medium (39%) risk, according to the OMS/ISH classification. The presence of left ventricular hypertrophy was considered if left ventricular mass index was > or = 134 or 110 g/m(2) in men and women, respectively (Devereux criteria). A logistic regression analysis was performed to identify factors associated to left ventricular hypertrophy.
  
  
  RESULTS
  The prevalence of left ventricular hypertrophy was 23.9% (95% CI:17.9-29.9), 25.6% in men and 22.6% in women. In the low risk group its prevalence was 20.7% and in medium risk group 29.5%. Factors associated to left ventricular hypertrophy were: years since the diagnosis of hypertension, OR:1.1 (95% CI:1.003-1.227); systolic blood pressure, OR:1.08 (95% CI:1.029-1.138); diastolic blood pressure, OR:0.9 (95% CI:0.882-0.991); and family history of cardiovascular disease, OR:4.3 (95% CI:1.52-12.18).
  
  
  CONCLUSIONS
  These findings underline the importance of performing an echocardiogram in low and high risk untreated hypertensive patients in which treatment would otherwise be delayed for even one year.
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario de la Princesa Madrid, Diego de León 62, 28006 Madrid, Spain. csuarezf@medynet.com
authors.forename: Carmen
authors.initials: C
authors.lastname: Suárez
authors.forename: José
authors.initials: J
authors.lastname: Villar
authors.forename: Nieves
authors.initials: N
authors.lastname: Martel
authors.forename: Blas Gil
authors.initials: BG
authors.lastname: Extremera
authors.forename: Najaty
authors.initials: N
authors.lastname: Suliman
authors.forename: Carlos
authors.initials: C
authors.lastname: Campo
authors.forename: Victoriano
authors.initials: V
authors.lastname: Castellanos
authors.forename: Antonio
authors.initials: A
authors.lastname: Liébana
authors.forename: Enrique
authors.initials: E
authors.lastname: Rodilla
authors.forename: Javier
authors.initials: J
authors.lastname: Nieto
authors.forename: Olga
authors.initials: O
authors.lastname: Velasco
authors.forename: Luis M
authors.initials: LM
authors.lastname: Ruilope
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D015995:Prevalence; D013030:Spain / Q000453:epidemiology