title: Global risk stratification in primary hypertension: the role of the kidney.
abstract: OBJECTIVE
  Microalbuminuria and a reduction in creatinine clearance are well known, independent predictors of unfavourable cardiovascular prognosis. Our aim was to evaluate the impact of renal damage on global risk stratification in 459 non-diabetic, untreated hypertensive patients (64% men, mean age 47.3 years).
  
  
  METHODS
  Renal damage was defined as creatinine clearance < 60 ml/min per 1.73 m2 (Cockcroft-Gault formula) or the presence of microalbuminuria (albumin to creatinine ratio). Cardiac and vascular organ damage was assessed by ultrasound scan. We evaluated the impact of renal damage, left ventricular hypertrophy and carotid atherosclerosis on risk stratification as recommended by the 2007 European Society of Hypertension-European Society of Cardiology Guidelines.
  
  
  RESULTS
  The prevalence of renal damage, microalbuminuria and creatinine clearance < 60 ml/min per 1.73 m2 was 24, 12 and 13%, respectively. There was no correlation between albuminuria and estimated creatinine clearance, and only 0.9% of patients showed microalbuminuria and reduced creatinine clearance simultaneously. The presence of renal damage entailed a 3.3 times higher risk of having cardiovascular abnormalities. Based on routine work-up, 58% of our study patients were classified as high-very high risk. The simultaneous evaluation of albuminuria and creatinine clearance resulted in a significant change in risk stratification, since 68% of patients were classified in the high-very high risk class. The search for left ventricular hypertrophy or carotid atherosclerosis by ultrasonography did not improve risk stratification significantly as compared to the assessment of renal damage.
  
  
  CONCLUSIONS
  Our findings support the assessment of renal abnormalities as the first step when evaluating target organ damage for cardiovascular risk assessment in hypertensive patients.
authors.affiliation: Department of Internal Medicine, University of Genoa, Azienda Ospedaliera Universitaria San Martino, Genoa, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Leoncini
authors.forename: Elena
authors.initials: E
authors.lastname: Ratto
authors.forename: Francesca
authors.initials: F
authors.lastname: Viazzi
authors.forename: Novella
authors.initials: N
authors.lastname: Conti
authors.forename: Valeria
authors.initials: V
authors.lastname: Falqui
authors.forename: Angelica
authors.initials: A
authors.lastname: Parodi
authors.forename: Cinzia
authors.initials: C
authors.lastname: Tomolillo
authors.forename: Giacomo
authors.initials: G
authors.lastname: Deferrari
authors.forename: Roberto
authors.initials: R
authors.lastname: Pontremoli
mesh_terms: D000419:Albuminuria / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications* / Q000503:physiopathology* / Q000652:urine; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D003404:Creatinine