title: Target organ damage assessment in French hypertensive patients without established cardiovascular or renal disease:  results of the PREVENT-A study.
abstract: OBJECTIVE
  To evaluate the modalities of subclinical target organ damage (TOD) assessment in France, 2-3 years after publication of the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) 2007 guidelines.
  
  
  METHODS
  Two parallel, large, cross-sectional surveys were performed in representative samples of 516 private practice cardiologists, and 943 general practitioners (GPs), in hypertensive patients (952 and 1778, respectively) without established cardiovascular or renal disease.
  
  
  RESULTS
  At least one TOD search was performed in 97.6% of cardiologists' patients, performed or ongoing in 96.1% of GPs' patients, with a median number of three TOD searches in both surveys. Only 8.6% of cardiologists' patients and 6.3% of GPs' patients had a full set of TOD analyses [i.e. the five categories investigated: left ventricular hypertrophy (LVH), vascular, renal, retinopathy and cerebrovascular]. When considering the three priority categories of subclinical TOD search recommended by the ESH/ESC guidelines (i.e. LVH, vascular and renal), 63.2% of cardiologists' patients and 49.5% of GPs' patients had this triple assessment completed. The new TOD assessment modalities, namely pulse wave velocity, ankle brachial index and microalbuminuria, were rarely used. Only 3.3% of GPs' patients and 15.4% of cardiologists' patients were reclassified with an upgraded cardiovascular risk.
  
  
  CONCLUSIONS
  Subclinical TOD modalities are commonly assessed in French hypertensive patients without established cardiovascular or renal diseases, although 55% still do not benefit from combined triple LVH, macrovascular and renal assessment. The new modalities of TOD assessment are rarely implemented. Moreover, TOD assessment displayed poor effectiveness in upgrading cardiovascular risk classification.
authors.affiliation: INSERM, Centre d'Investigations Cliniques-9501, Nancy, France. p.rossignol@chu-nancy.fr
authors.forename: Patrick
authors.initials: P
authors.lastname: Rossignol
authors.forename: Kossar
authors.initials: K
authors.lastname: Hosseini
authors.forename: Anne-Isabelle
authors.initials: AI
authors.lastname: Tropeano
authors.forename: Renaud
authors.initials: R
authors.lastname: Fay
authors.forename: Anne
authors.initials: A
authors.lastname: Tsatsaris
authors.forename: Francis
authors.initials: F
authors.lastname: Guillemin
authors.forename: Claire
authors.initials: C
authors.lastname: Mounier-Vehier
mesh_terms: D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000191:economics; D007674:Kidney Diseases / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000191:economics / Q000379:methods*; D012307:Risk Factors