BACKGROUND: Hypertension guidelines underline the importance of quantification of total cardiovascular risk; an extensive evaluation of target organ damage (TOD) may increase the number of patients classified at high-added cardiovascular risk. OBJECTIVE: To assess the effect of the evaluation of different forms of TOD, in addition to 'routine' workup, on cardiovascular risk stratification in a general population sample in Northern Italy. METHODS: In 385 patients (age 57 +/- 10 years, 44% men, 64% hypertensives, 32% treated), left ventricular and carotid artery structure and carotid-femoral pulse wave velocity (PWV) were measured. All patients underwent laboratory examinations. Patients were divided into risk categories according to European Society of Hypertension/European Society of Cardiology guidelines before and after TOD evaluation. RESULTS: After routine workup, patients were classified as follows: 6% at average cardiovascular risk, 35% at low cardiovascular risk, 25% at moderate cardiovascular risk, 33% at high cardiovascular risk and 1% at very high cardiovascular risk. The proportion of patients at low or moderate cardiovascular risk reclassified at high cardiovascular risk were 5, 14, 30 and 14% after echocardiography, measurement of albuminuria and estimated glomerular filtration rate, carotid ultrasound and PWV, respectively (chi P < 0.001 for all vs. routine). Assessment of PWV in addition to echocardiography led to an increase of the proportion of patients at high risk (from 5 to 15%, P < 0.001), as for PWV in addition to albuminuria, estimated glomerular filtration rate or both (from 14 to 31%, P < 0.01), but did not affect risk stratification in addition to carotid ultrasound (from 30 to 34%, P = NS). CONCLUSION: Our data suggest that measurement of PWV may significantly change cardiovascular risk stratification in addition to echocardiography and to detection of albuminuria and/or of a reduction of estimated glomerular filtration rate, but not after carotid ultrasound. Our results confirm that evaluation of different forms of TOD is useful for a more accurate assessment of global cardiovascular risk.
BACKGROUND:Hypertension guidelines underline the importance of quantification of total cardiovascular risk; an extensive evaluation of target organ damage (TOD) may increase the number of patients classified at high-added cardiovascular risk. OBJECTIVE: To assess the effect of the evaluation of different forms of TOD, in addition to 'routine' workup, on cardiovascular risk stratification in a general population sample in Northern Italy. METHODS: In 385 patients (age 57 +/- 10 years, 44% men, 64% hypertensives, 32% treated), left ventricular and carotid artery structure and carotid-femoral pulse wave velocity (PWV) were measured. All patients underwent laboratory examinations. Patients were divided into risk categories according to European Society of Hypertension/European Society of Cardiology guidelines before and after TOD evaluation. RESULTS: After routine workup, patients were classified as follows: 6% at average cardiovascular risk, 35% at low cardiovascular risk, 25% at moderate cardiovascular risk, 33% at high cardiovascular risk and 1% at very high cardiovascular risk. The proportion of patients at low or moderate cardiovascular risk reclassified at high cardiovascular risk were 5, 14, 30 and 14% after echocardiography, measurement of albuminuria and estimated glomerular filtration rate, carotid ultrasound and PWV, respectively (chi P < 0.001 for all vs. routine). Assessment of PWV in addition to echocardiography led to an increase of the proportion of patients at high risk (from 5 to 15%, P < 0.001), as for PWV in addition to albuminuria, estimated glomerular filtration rate or both (from 14 to 31%, P < 0.01), but did not affect risk stratification in addition to carotid ultrasound (from 30 to 34%, P = NS). CONCLUSION: Our data suggest that measurement of PWV may significantly change cardiovascular risk stratification in addition to echocardiography and to detection of albuminuria and/or of a reduction of estimated glomerular filtration rate, but not after carotid ultrasound. Our results confirm that evaluation of different forms of TOD is useful for a more accurate assessment of global cardiovascular risk.
Authors: Alfonso Tatasciore; Marta Di Nicola; Roberto Tommasi; Francesco Santarelli; Carlo Palombo; Gianfranco Parati; Raffaele De Caterina Journal: J Clin Hypertens (Greenwich) Date: 2020-07-08 Impact factor: 3.738
Authors: Simone Theilade; Maria Lajer; Frederik Persson; Christel Joergensen; Peter Rossing Journal: Diabetes Care Date: 2012-11-27 Impact factor: 19.112
Authors: Amy V Jones; Rachael A Evans; William D-C Man; Charlotte E Bolton; Samantha Breen; Patrick J Doherty; Nikki Gardiner; Linzy Houchen-Wolloff; John R Hurst; Kate Jolly; Matthew Maddocks; Jennifer K Quint; Olivia Revitt; Lauren B Sherar; Rod S Taylor; Amye Watt; Jennifer Wingham; Janelle Yorke; Sally J Singh Journal: Chron Respir Dis Date: 2019 Jan-Dec Impact factor: 2.444