title: World Health Organization cardiovascular risk stratification and target organ damage.
abstract: BACKGROUND
  Prediction charts allow treatment to be targeted according to simple markers of cardiovascular risk; many algorithms do not recommend screening asymptomatic target organ damage which could change dramatically the assessment.
  
  
  OBJECTIVE
  To demonstrate that target organ damage is present in low cardiovascular risk hypertensive patients and it is more frequent and severe as global cardiovascular risk increases.
  
  
  METHODS
  Consecutive hypertensive patients treated at a single Latin American center. Cardiovascular risk stratified according to 2013 WHO/ISH risk prediction chart America B. Left ventricular mass assessed by Devereux method, left ventricular hypertrophy considered >95g/m(2) in women and >115g/m(2) in men. Transmitral diastolic peak early flow velocity to average septal/lateral peak early diastolic relaxation velocity (E/e' ratio) measured cut off value >13. Systolic function assessed by tissue Doppler average interventricular septum/lateral wall mitral annulus rate systolic excursion (s wave).
  
  
  RESULTS
  A total of 292 patients were included of whom 159 patients (54.5%) had cardiovascular risk of <10%, 90 (30.8%) had cardiovascular risk of 10-20% and 43 (14.7%) had cardiovascular risk of >20%. Left ventricular hypertrophy was detected in 17.6% low risk patients, 27.8% in medium risk and 23.3% in high risk (p<0.05), abnormal E/e' ratio was found in 13.8%, 31.1% and 27.9%, respectively (p<0.05). Mean s wave was 8.03+8, 8.1+9 and 8.7+1cm/s for low, intermediate and high risk patients, respectively (p<0.025).
  
  
  CONCLUSIONS
  Target organ damage is more frequent and severe in high risk; one over four subjects was misclassified due to the presence of asymptomatic target organ damage.
authors.affiliation: Instituto de Cardiología, Sanatorio Británico SA, Paraguay 40, 2000 Rosario, Argentina; Centro de Investigaciones Cardiovasculares, Sanatorio Británico SA, Paraguay 40, 2000 Rosario, Argentina. Electronic address: danielpiskorz@ciudad.com.ar.
authors.forename: D
authors.initials: D
authors.lastname: Piskorz
authors.affiliation: Instituto de Cardiología, Sanatorio Británico SA, Paraguay 40, 2000 Rosario, Argentina.
authors.forename: L
authors.initials: L
authors.lastname: Bongarzoni
authors.affiliation: Instituto de Cardiología, Sanatorio Británico SA, Paraguay 40, 2000 Rosario, Argentina.
authors.forename: L
authors.initials: L
authors.lastname: Citta
authors.affiliation: Instituto de Cardiología, Sanatorio Británico SA, Paraguay 40, 2000 Rosario, Argentina.
authors.forename: N
authors.initials: N
authors.lastname: Citta
authors.affiliation: Instituto de Cardiología, Sanatorio Británico SA, Paraguay 40, 2000 Rosario, Argentina.
authors.forename: P
authors.initials: P
authors.lastname: Citta
authors.affiliation: Instituto de Cardiología, Sanatorio Británico SA, Paraguay 40, 2000 Rosario, Argentina.
authors.forename: L
authors.initials: L
authors.lastname: Keller
authors.affiliation: Instituto de Cardiología, Sanatorio Británico SA, Paraguay 40, 2000 Rosario, Argentina.
authors.forename: L
authors.initials: L
authors.lastname: Mata
authors.affiliation: Centro de Investigaciones Cardiovasculares, Sanatorio Británico SA, Paraguay 40, 2000 Rosario, Argentina.
authors.forename: A
authors.initials: A
authors.lastname: Tommasi
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular; D008297:Male; D012307:Risk Factors; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis; D016277:Ventricular Function, Left; D014944:World Health Organization
keywords: Daño órgano blanco; Disfunción ventricular izquierda; Estratificación riesgo; Hipertensión; Hipertrofia ventricular izquierda; Hypertension; Left ventricular dysfunction; Left ventricular hypertrophy; Risk stratification; Target organ damage