title: Why is cardiovascular risk stratification important in hypertensive patients?
abstract: BACKGROUND
  The aim is to evaluate whether cardiovascular (CV) risk stratification in newly diagnosed hypertensive patients according to the European Society of Hypertension (ESH) guidelines, can predict the evolution of target organ damage (TOD) using routine examinations in clinical practice during 1 year.
  
  
  METHODS
  Prospective study of recently diagnosed untreated hypertensives. At the moment of inclusion and 1 year later, urinary albumin excretion rate (UAER), blood analysis, electrocardiogram, retinography, self-monitored blood pressure (BP) and ambulatory BP measurement were performed. TOD was defined following the ESH guidelines and evaluated as having favorable or unfavorable evolution.
  
  
  RESULTS
  Four hundred and seventy-nine hypertensive patients were included (58.8 years; 43.4% women). The baseline prevalence of TOD was: high UAER (2.4%), left ventricular hypertrophy (LVH) (20.7%), advanced lesion of the fundus oculi (FO) (10.2%). After 1 year, no differences were found between the final systolic and diastolic BP neither in the high/very high nor in the low/moderate CV risk groups. Patients with low/moderate CV risk had less unfavorable TOD evolution, LVH (9.2% vs 41.7%; p <0.001), FO advanced damage (0.99% vs 14.3%; p <0.001), high UAER (0.3% vs 5.1%; p <0.005) and amount of TOD (9.2% vs 44.0%; 0<0.001) than those with high/very high CV risk. The odds ratios of favorable TOD evolution adjusted for BP change and antihypertensive drug treatment were (low/moderate vs high/very high CV risk); 5.14 (95% confidence interval, CI, 3.99-6.64) for LVH; 12.42 (6.67-23.14) FO advanced damage; 10.71 (3.67-31.22) high UAER and 13.99 (10.18-19.22) for amount of TOD.
  
  
  CONCLUSIONS
  It is possible to detect variations in TOD in hypertensive patients with a 1-year follow-up using the examinations available in routine clinic practice. The risk determined by the ESH guidelines predicts the evolution of TOD at 1 year.
authors.affiliation: Primary Care, Health Care Institute, Parc Hospitalari Martí i Julià, Dr. Castany s/n, Salt, Girona, Spain. gabriel.coll@ias.scs.es
authors.forename: Gabriel
authors.initials: G
authors.lastname: Coll-De-Tuero
authors.forename: Marc
authors.initials: M
authors.lastname: Saez
authors.forename: Antonio
authors.initials: A
authors.lastname: Rodriguez-Poncelas
authors.forename: Antonia
authors.initials: A
authors.lastname: Barceló-Rado
authors.forename: Susanna
authors.initials: S
authors.lastname: Vargas-Vila
authors.forename: Josep
authors.initials: J
authors.lastname: Garre-Olmo
authors.forename: Victoria
authors.initials: V
authors.lastname: Sala
authors.forename: Angels
authors.initials: A
authors.lastname: Sieira
authors.forename: Esther
authors.initials: E
authors.lastname: Gelada
authors.forename: Jesús
authors.initials: J
authors.lastname: Gelado-Ferrero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D055815:Young Adult