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Can echocardiography identify mildly hypertensive patients at high risk, left untreated based on current guidelines?

E Abergel1, G Chatellier, C Battaglia

  • 1Centre d'Investigations Cliniques, Paris, France. eric.abergel@brs.ap-hop-paris.fr

Journal of Hypertension
|August 25, 1999
PubMed

Insights

Mild hypertension treatment guidelines may miss high-risk patients. Echocardiography revealed that some patients with concentric left ventricular (LV) remodelling, indicating higher coronary disease risk, were left untreated despite following WHO/ISH guidelines.

Area of Science:

  • Cardiology
  • Hypertension Management
  • Diagnostic Imaging

Background:

  • Mild hypertension requires careful management to balance treatment benefits against risks.
  • Echocardiography can assess cardiac structure and identify patients at higher cardiovascular risk.
  • Current guidelines (WHO/ISH) for treating mild hypertension rely on blood pressure measurements over time.

Purpose of the Study:

  • To evaluate if current guidelines for treating mild hypertension identify patients who are at high risk based on echocardiographic findings.
  • To compare echocardiographic parameters between treated and untreated mild hypertensive patients.

Main Methods:

  • 118 patients with mild hypertension (BP 140-180/90-105 mm Hg) underwent echocardiography.
  • Patients were followed for 6 months by a physician unaware of echographic results.
  • Treatment decisions were based on WHO/ISH guidelines using serial blood pressure measurements.

Main Results:

  • Treated patients (n=48) showed higher left ventricular (LV) mass and more concentric LV geometry than untreated patients (n=70).
  • 20 patients had LV concentric remodelling, associated with a higher 10-year coronary disease risk (10.4% vs 4.2%).
  • Nine patients with concentric remodelling remained untreated at study end.

Conclusions:

  • Strict adherence to WHO/ISH guidelines for mild hypertension resulted in treating patients with slightly increased LV mass and concentricity.
  • A subgroup of high-risk patients with LV concentric remodelling was not identified by these guidelines and remained untreated.
  • Echocardiography may be valuable in refining risk stratification for mild hypertension management.
Abstract

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