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Change in cardiovascular risk profile by echocardiography in low- or medium-risk hypertension
Giuseppe Schillaci1, Giovanni De Simone, Gianpaolo Reboldi
1Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy. skill@unipg.it
Insights
Echocardiography significantly alters cardiovascular risk stratification in untreated hypertensive patients. This imaging technique identifies a need for immediate drug treatment in 29% of individuals initially deemed low-risk by WHO-ISH guidelines.
Area of Science:
- Cardiology
- Hypertension Management
- Diagnostic Imaging
Background:
- Clinical decision-making for hypertension relies on total cardiovascular risk assessment.
- Current World Health Organization-International Society of Hypertension (WHO-ISH) guidelines may exclude echocardiography in low-risk patient work-ups.
- This can lead to delayed or withheld drug treatment for certain individuals.
Purpose of the Study:
- To evaluate the impact of echocardiography on cardiovascular risk stratification.
- To assess changes in risk classification for never-treated hypertensive patients initially categorized as low-risk.
- To determine if echocardiography reveals a need for immediate treatment in these patients.
Main Methods:
- Retrospective analysis of a prospective survey.
- Involved 792 never-treated hypertensive adults from outpatient clinics.
- Echocardiography was used to assess left ventricular hypertrophy, a key factor in risk stratification.
Main Results:
- 29% of untreated hypertensive patients, initially classified as low or medium risk by WHO-ISH, had left ventricular hypertrophy detected by echocardiography.
- Echocardiography modified the risk classification in 29% of cases.
- This identified a need for immediate drug treatment in a significant portion of the study population.
Conclusions:
- Echocardiography is crucial for accurate risk stratification in untreated hypertensive patients.
- It frequently alters initial risk assessments made by WHO-ISH guidelines.
- The findings support the use of echocardiography to identify patients requiring prompt antihypertensive medication, even if initially classified as low-risk.
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.