title: Cumulative Effects of Several Target Organ Damages in Risk Assessment in Hypertension.
abstract: BACKGROUND
  The prognostic value of screening multiple target organ damages (TODs) in hypertensive subjects has not been extensively studied. We estimated the prognostic value of considering 3 TODs in estimating the 10-year survival in hypertensive subjects.
  
  
  METHODS
  At baseline 1,848 out of a cohort of 1,963 hypertensive patients had a previous cardiovascular disease (CVD) or assessments of 3 TODs: Modification in Diet in Renal Disease (MDRD) <60ml/min or albuminuria >300mg/day, Sokolow index >3.5 mV, and advanced hypertensive retinopathy (grades 3 and 4 of Keith-Wagener-Barker classification). The cohort was divided into 5 groups: 0 TOD (N = 978), 1 TOD (N = 308), 2 TODs (N = 94), 3 TODs (N = 30), and previous CVD (N = 438).
  
  
  RESULTS
  After 10 years of follow-up, we observed 418 deaths of which 254 from cardiovascular cause. The adjusted hazard ratios for the major cardiovascular risk factors showed a progressive risk associated with the number of TODs. For all-cause death, the hazard ratios [95% confidence intervals] vs. 0 TOD of the other 4 groups were 1.91 [1.39-2.63], 1.99 [1.28-3.10], 4.33 [2.42-7.72], and 3.09 [2.35-4.05], respectively. For cardiovascular death, the hazard ratios [95% confidence intervals] were of the same order of magnitude: 2.14 [1.38-3.32], 2.12 [1.15-3.89], 4.22 [1.83-9.72], and 4.24 [2.95-6.11], respectively.
  
  
  CONCLUSIONS
  Our results indicate that hypertensive patients with several TODs had a worst outcome. Thus, it seems important to screen for multiple TODs in hypertension; especially check for severe hypertensive retinopathy in patients with left ventricular hypertrophy (LVH) and renal damage.
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Lyon-1, Villeurbanne, France; Génomique Fonctionnelle de l'Hypertension Artérielle, Lyon, France;
authors.forename: Brahim
authors.initials: B
authors.lastname: Harbaoui
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Lyon-1, Villeurbanne, France; Génomique Fonctionnelle de l'Hypertension Artérielle, Lyon, France; pycourand@hotmail.com.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Courand
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France;
authors.forename: Alice
authors.initials: A
authors.lastname: Defforges
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France;
authors.forename: Fouad
authors.initials: F
authors.lastname: Khettab
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France;
authors.forename: Hugues
authors.initials: H
authors.lastname: Milon
authors.affiliation: Inserm, Centre D'investigations Cliniques 9501 & U1116, Université de Lorraine, Institut Lorrain du cœur et des Vaisseaux Louis-Mathieu, Vandœuvre-lès-Nancy, France;
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girerd
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Lyon-1, Villeurbanne, France; Génomique Fonctionnelle de l'Hypertension Artérielle, Lyon, France; Cardiology Department, Hôpital Nord Ouest, Villefranche-sur-Saône, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lantelme
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000401:mortality / Q000473:pathology; D058437:Hypertensive Retinopathy / Q000175:diagnosis*; D017379:Hypertrophy, Left Ventricular / Q000209:etiology*; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051437:Renal Insufficiency / Q000209:etiology*; D012160:Retina / Q000473:pathology; D018570:Risk Assessment; D016019:Survival Analysis
keywords: blood pressure; hypertension; hypertensive retinopathy; kidney; left ventricular hypertrophy.