Carotid atherosclerosis and cardiovascular risk stratification: role and cost-effectiveness of echo-Doppler examination in untreated essential hypertensives.
OBJECTIVE
To investigate the impact and cost-effectiveness of carotid ultrasonographic examination on total risk stratification in low-medium risk hypertensive patients in relation to age (< 50 and > 50 years) and gender.


METHODS
Five hundred and eighty untreated hypertensives classified at low-medium risk, after the routine work-up recommended by the 2003 ESH/ ESC guidelines, were included in the study and total risk was reassessed by adding the results of carotid ultrasonography.


RESULTS
According to the stratification based on routine work-up 16.3% of the whole population was considered at low added risk and 83.7% at medium added risk. Carotid subclinical damage was found in 158 patients (27.0%), who were then reclassified in the high-risk stratum. Prevalence rates of patients reclassified in the high-risk stratum as a consequence of carotid damage were as follows: 12.6% in men < 50 years, 14.1% in women < 50 years, 53.0% in men > or = 50 years and 40.1% in women > or = 50 years. The cost per detected case of carotid atherosclerosis was 473 euro in patients < 50 years and 133 euro in those > or = 50 years.


CONCLUSIONS
Our results show that: (i) the use of carotid ultrasonography allows a much more accurate identification of high-risk individuals; (ii) its impact and cost-effectiveness on the risk stratification process differs markedly according to the age and gender; (iii) the selective use of this procedure in subjects at high risk of target organ damage may substantially improve the cost of primary prevention.
Cuspidi
Cesare
C
Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy. dhipertensione@libero.it
Meani
Stefano
S
Valerio
Cristiana
C
Fusi
Veronica
V
Sala
Carla
C
Zanchetti
Alberto
A
Mancia
Giuseppe
G
D000328:Adult; D000367:Age Factors; D000368:Aged; D001161:Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000191:economics / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000191:economics / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D018608:Ultrasonography, Doppler / Q000191:economics