Intensive cardiovascular examination regarding blood pressure levels: evaluation of risk groups. ICEBERG study.
OBJECTIVE
Assessment of total cardiovascular risk level is crucial for approaching hypertensive patients. Therefore, the aim of the Intensive/Initial Cardiovascular Examination regarding Blood pressure levels: Evaluation of Risk Groups (ICEBERG) study is to determine cardiovascular risk evaluation and stratification of subjects with high normal and high blood pressure (BP > or = 130/85 mmHg), and to evaluate the impact of laboratory tests on this stratification.


METHODS
ICEBERG was an epidemiological study conducted at 20 university hospitals and 197 primary healthcare centers. A total of 10,313 patients, who were diagnosed with high BP and under antihypertensive treatment or not antihypertensive under treatment at least for the last 3 months were selected. Besides routine clinical evaluation, microalbuminuria (MAU) and high sensitive C-reactive protein (hs-CRP) tests, echocardiography (Echo) and carotid ultrasonography (USG) were performed in selected arms. The patients were stratified into low, moderate, high and very high added risk groups as described by the European Society of Hypertension/European Society of Cardiology Guidelines Committee (2003).


RESULTS
Upon routine evaluation, the percentage of "high and very high added cardiovascular risk" groups was between 51.2% and 60.7% in different study arms. This percentage increased to 62.9% by subsequent serum biochemistry assessment and to 76.2% by hs-CRP test results. Switching upwards to "high and very high added risk" groups was around 6% when MAU results were used, with a 4.9% upwards switch to "high and very high added risk" groups when Echo was performed; this proportion increased by 6.8%, when carotid USG was taken into account.


CONCLUSIONS
Cardiovascular risk evaluation by intensive cardiovascular examination including Echo and carotid USG provided more accurate risk stratification. Furthermore, a simple test to demonstrate presence of MAU usable at primary healthcare level will also help to evaluate the patient's risk profile better than routine assessment methods alone.
Buyukozturk
Kemalettin
K
Cardiology Department, Istanbul Medical School, Istanbul University, Istanbul, Turkey. buyukozturk@gediknet.com
Ilerigelen
Baris
B
Kabakci
Giray
G
Koylan
Nevres
N
Kozan
Omer
O
D000368:Aged; D000419:Albuminuria; D001794:Blood Pressure; D001795:Blood Pressure Determination; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D003935:Diagnostic Techniques, Cardiovascular / Q000592:standards*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008722:Methods; D008875:Middle Aged; D012307:Risk Factors; D014463:Ultrasonography