title: Cardiovascular risk assessment in hypertensive patients with tests recommended by the European Guidelines on Hypertension.
abstract: OBJECTIVE
  To evaluate the usefulness of the diagnostic tests recommended by the European Society of Hypertension/Cardiology Guidelines (ESH-ESC 2007) in hypertensive patients classified as being at low or moderate risk, analyzing the change to high risk classification and the characteristics associated with such change.
  
  
  METHODS
  A cross-sectional study was made in 391 patients aged between 30 and 80 years recently diagnosed with arterial hypertension in the Primary Care setting. The criteria of the 2007 ESH-ESC Guidelines were followed for the evaluation of risk factors, subclinical organ damage, cardiovascular disease and cardiovascular risk. In addition to the routine tests, echocardiography, carotid ultrasound, albumin/creatinine ratio, estimated glomerular filtration rate, ankle-brachial index, pulse wave velocity and retinography were used. We established four levels of testing performed for risk classification.
  
  
  RESULTS
  Using the routine tests to evaluate risk (level 1), 218 (55.8%) patients were classified as being at high risk. Of the 173 patients classified as presenting low or moderate risk, the ankle-brachial index, albumin/creatinine ratio and glomerular filtration rate were determined (level 2), and 18 patients (10.4%) were classified as being at high risk. With echocardiography and carotid ultrasound (level 3), another 16 patients (10%) were raised to high risk. Finally, with pulse wave velocity and retinography (level 4), 10 additional patients (5%) were classified as presenting high risk. Patients with increased blood pressure, advanced age and women showed a 4.28-fold (95%CI: 2.01-9.16), 3.54-fold (95%CI: 1.61-7.77) and 1.36-fold (95%CI: 0.62-3.00) higher probability of being reclassified to high cardiovascular risk, respectively.
  
  
  CONCLUSIONS
  With the non-routine tests, 25.4% of the low or moderate risk patients were reclassified as presenting high risk.
authors: Primary Care Research Unit, La Alamedilla Health Center, REDIAPP, Salamanca, Spain.
authors: Manuel A
authors: MA
authors: Gómez-Marcos
authors: Luis J
authors: LJ
authors: González-Elena
authors: José I
authors: JI
authors: Recio-Rodríguez
authors: Emiliano
authors: E
authors: Rodríguez-Sánchez
authors: Rosa
authors: R
authors: Magallón-Botaya
authors: Maria F E
authors: MF
authors: Muñoz-Moreno
authors: Maria C
authors: MC
authors: Patino-Alonso
authors: Luis
authors: L
authors: García-Ortiz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003935:Diagnostic Techniques, Cardiovascular / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000592:standards; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain