BACKGROUND: Clinical decision-making in hypertensive patients is largely based upon assessment of total cardiovascular risk. World Health Organization-International Society of Hypertension (WHO-ISH) guidelines suggest delaying or withholding drug treatment in individuals assessed as at low risk on the basis of a suggested work-up that does not include echocardiography. OBJECTIVE: To assess the impact of echocardiography on risk stratification in never-treated individuals classified as at low cardiovascular risk. DESIGN: A retrospective analysis of a prospective survey. SETTING: Outpatient hypertension clinics of three community hospitals. PATIENTS: A total of 792 hypertensive adults classified as at low or medium risk, drawn from a larger sample of 1322 never-treated hypertensive patients. MAIN OUTCOME MEASURES: Change in risk class and need of immediate treatment after echocardiographic evaluation of left ventricular hypertrophy. RESULTS: Those at low and medium risk according to WHO-ISH (to receive delayed treatment) represented 17 and 43%, respectively, of the whole hypertensive population. The prevalence of left ventricular hypertrophy on echocardiography was 21 and 32% in low- and medium-risk groups, respectively (29% on average). CONCLUSIONS: In untreated hypertensive individuals without overt target-organ damage, in whom treatment would be postponed or avoided according to current WHO-ISH guidelines, echocardiography modifies the risk classification in 29% of the cases, identifying a need for immediate drug treatment. In low-risk untreated hypertensive individuals, echocardiography commonly alters risk stratification based on the initial WHO-ISH work-up.
BACKGROUND: Clinical decision-making in hypertensivepatients is largely based upon assessment of total cardiovascular risk. World Health Organization-International Society of Hypertension (WHO-ISH) guidelines suggest delaying or withholding drug treatment in individuals assessed as at low risk on the basis of a suggested work-up that does not include echocardiography. OBJECTIVE: To assess the impact of echocardiography on risk stratification in never-treated individuals classified as at low cardiovascular risk. DESIGN: A retrospective analysis of a prospective survey. SETTING:Outpatienthypertension clinics of three community hospitals. PATIENTS: A total of 792 hypertensive adults classified as at low or medium risk, drawn from a larger sample of 1322 never-treated hypertensivepatients. MAIN OUTCOME MEASURES: Change in risk class and need of immediate treatment after echocardiographic evaluation of left ventricular hypertrophy. RESULTS: Those at low and medium risk according to WHO-ISH (to receive delayed treatment) represented 17 and 43%, respectively, of the whole hypertensive population. The prevalence of left ventricular hypertrophy on echocardiography was 21 and 32% in low- and medium-risk groups, respectively (29% on average). CONCLUSIONS: In untreated hypertensive individuals without overt target-organ damage, in whom treatment would be postponed or avoided according to current WHO-ISH guidelines, echocardiography modifies the risk classification in 29% of the cases, identifying a need for immediate drug treatment. In low-risk untreated hypertensive individuals, echocardiography commonly alters risk stratification based on the initial WHO-ISH work-up.
Authors: Esther Y Yoon; Lisa Cohn; Albert Rocchini; David Kershaw; Gary Freed; Frank Ascione; Sarah Clark Journal: Arch Pediatr Adolesc Med Date: 2012-09
Authors: Giovanni de Simone; Costantino Mancusi; Roberta Esposito; Nicola De Luca; Maurizio Galderisi Journal: High Blood Press Cardiovasc Prev Date: 2018-05-02
Authors: Małgorzata Chlabicz; Jacek Jamiołkowski; Marlena Paniczko; Paweł Sowa; Małgorzata Szpakowicz; Magda Łapińska; Natalia Jurczuk; Marcin Kondraciuk; Katarzyna Ptaszyńska-Kopczyńska; Andrzej Raczkowski; Anna Szpakowicz; Karol Adam Kamiński Journal: J Clin Med Date: 2020-05-06 Impact factor: 4.241