Utilization of guidelines for the management of hypertension in cardiovascular risk scoring of renal patients.
BACKGROUND
Recent guidelines for the management of hypertension by the European Societies of Hypertension and Cardiology (ESH-ESC), consider, besides normal and normal high blood pressure, also early renal failure as a significant factor scoring the individual cardiovascular (CV) risk in each patient. Considering that the nephrologists have not yet adopted a similar system to score CV risk in renal failure, we believed reasonable to evaluate whether the ESH-ESC guidelines were applicable to renal patients and to what extent useful to estimate the CV risk in chronic renal disease.


METHODS
According to the above-mentioned guidelines, CV risk score was evaluated in 386 ambulatory patients (212 M/174 F; aged 53 +/- 15 years) with the following clinical diagnosis: hypertension (n=48), lithiasis (n=49), chronic renal failure (n=182), transplantation (n=61) and dialysis (n=46).


RESULTS
We obtained a "no score" group and five progressive risk classes graded from 1 to 5. Infact thirthyfour cases were not scored because of "optimal" blood pressure control, whilst the remaining 352 averaged a score of 3.9 +/- 1.1 ("high" CV risk condition). In these, all the scores were present and the distribution of cases evidenced a prevailing of score 4 and 5 in chronic renal failure (19 and 52% of the cases, respectively) and in transplantation (26% and 39%), but not in hypertension and lithiasis. In dialysis, only score 4 and 5 (35% and 59% respectively) occurred, while 4 cases (6%) were not scored due to "optimal" blood pressure values. Target organ damage, acquired clinical conditions, modifiable and non-modifiable risk factors had all a positive correlation with the risk score.


CONCLUSIONS
Our study suggests that ESH-ESC guidelines for the management of hypertension can be used to obtain a global CV risk score also in chronic kidney diseases, with the exception of dialysis. In chronic renal failure, the risk of underestimating the real incidence of future CV events might be overcome, at least partially, by the possibility of highlighting in individual patients the concomitance of risk factors requiring a very early preventive and aggressive therapy.
Mazzaferro
S
S
Department of Clinical Science, University La Sapienza of Rome, Italy. sandro.mazzaferro@uniroma1.it
Barresi
G
G
Baldinelli
M
M
Malagnino
E
E
Matera
G
G
Otranto
G
G
Pasquali
M
M
Pugliese
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors