Risk stratification with the risk chart from the European Society of Hypertension compared with SCORE in the general population.
OBJECTIVE
The risk chart from the European Society of Hypertension (ESH) and Systemic Coronary Risk Evaluation (SCORE) from the European Society of Cardiology (ESC) are equally recommended tools for risk stratification. However, ESH risk chart recommends measuring subclinical organ damage, whereas SCORE is based on traditional risk factors. We wanted to compare the predictive performance of the two charts.


METHODS
In a Danish population sample of 1344 individuals aged 41, 51, 61 and 71 years without known diabetes, prior stroke or myocardial infarction, not receiving cardiovascular, antidiabetic or lipid-lowering medications and with higher than optimal blood pressure (> or =120/80 mmHg), we measured traditional risk factors and subclinical organ damage. The endpoints were cardiovascular death and a composite of cardiovascular death, nonfatal myocardial infarction and stroke (CEP).


RESULTS
During the following 12.8 years cardiovascular death and CEP occurred in 71 and 132 patients, respectively. Forty-two percent had unrecognized hypertension. The sizes and characteristics of the populations in the different risk categories of the charts varied considerably as ESH risk chart allocated 368 patients to higher-risk categories than SCORE (P < 0.001). These patients were younger, with higher blood pressure and less frequently male smokers. However, ESH risk chart agreed with ESC guidelines for antihypertensive treatment using SCORE in 89% (634/713) of the patients recommended treatment and produced similar sensitivities (79 vs. 79%), specificities (46 vs. 50%), positive (14 vs. 15%) and negative (95 vs. 96%) predictive values for CEP.


CONCLUSIONS
Although SCORE did not use subclinical organ damage, the guidelines by ESH and ESC using SCORE recommended antihypertensive treatment in almost the same patients.
Sehestedt
Thomas
T
Cardiovascular Research Unit, Department of Internal Medicine, Glostrup University Hospital, Denmark. ts@heart.dk
Jeppesen
Jørgen
J
Hansen
Tine W
TW
Rasmussen
Susanne
S
Wachtell
Kristian
K
Ibsen
Hans
H
Torp-Pedersen
Christian
C
Olsen
Michael H
MH
D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000175:diagnosis; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000473:pathology; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005263:Femoral Artery; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000401:mortality / Q000517:prevention & control; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D015996:Survival Rate; D014463:Ultrasonography