Related Experiment Videos
Change in cardiovascular risk profile by echocardiography in medium-risk elderly hypertensives
C Cuspidi1, L Michev, B Severgnini
1Istituto di Clinica e Terapia Medica, Centro di Fisologia Clinica e Ipertensione, Università di Milano, Ospedale Maggiore IRCCS, Via F. Sforza 35, 20122 Milan, Italy. dhipertensione@libero.it
Insights
Echocardiography reveals left ventricular hypertrophy (LVH) in elderly hypertensive patients, significantly altering cardiovascular risk assessment. Adding LVH to routine methods provides a more accurate global cardiovascular risk profile.
Area of Science:
- Cardiology
- Geriatrics
- Hypertension Research
Background:
- Ageing and arterial hypertension increase left ventricular hypertrophy (LVH) prevalence.
- LVH is a significant risk factor for cardiovascular (CV) events.
- Accurate CV risk stratification is crucial for elderly hypertensive patients.
Purpose of the Study:
- To evaluate the impact of echocardiographic LVH on absolute CV risk stratification.
- To compare WHO/ISH guideline-based risk profiling with and without echocardiographic LVH assessment.
- To determine the utility of cardiac imaging in refining risk assessment for elderly hypertensives.
Main Methods:
- Included 223 treatment-naive elderly patients (>=65 years) with essential hypertension.
- Performed medical history, physical exam, BP measurement, blood/urine tests, and ECG.
- Stratified CV risk using WHO/ISH guidelines, then reassessed with echocardiographic LVH (LV mass index).
Main Results:
- Initially, 56% were medium-risk, 29% high-risk, and 15% very-high-risk.
- Overall LVH prevalence was 56%, higher in high/very-high-risk groups (P<0.01).
- Incorporating LVH shifted risk: medium-risk decreased to 29%, high-risk increased to 56% (P<0.01).
Conclusions:
- Echocardiographic assessment of cardiac target organ damage (LVH) is vital for accurate CV risk evaluation.
- Routine diagnostic procedures may underestimate CV risk in a substantial portion of medium-risk elderly hypertensive patients.
- Ultrasound imaging enhances the validity of global cardiovascular risk assessment in this population.
Abstract:
It has been clearly demonstrated that ageing and arterial hypertension are both associated with an increased prevalence of left ventricular hypertrophy (LVH), which is a powerful risk factor for cardiovascular (CV) events. The objective of this study was to assess the impact of echocardiographic LVH in profiling the absolute CV risk stratification according to the 1999 World Health Organization-International Society of Hypertension (WHO/ISH) guidelines in elderly hypertensive patients. A total of 223 never-treated elderly patients (> or =65 years) with essential hypertension (98 men, 125 women, mean age 72+/-5 years) referred to our outpatient hospital clinic were included in the study. They underwent the following procedures: (1) medical history, physical examination, and clinic blood pressure; (2) routine blood chemistry and urine analysis and (3) electrocardiogram. The risk was initially stratified according to the routine procedures suggested by WHO/ISH guidelines and subsequently reassessed by adding the results of echocardiography (LVH as left ventricular mass index >51 g/m(2.7) in men and >47g/m(2.7) in women). According to routine classification, 56% (n=125) were medium-risk patients, 29% (64) high-risk and 15% (34) very-high-risk patients. The overall prevalence of LVH was 56% (48% in medium-risk and 62% in high-risk or very-high-risk patients, P<0.01). A marked change in risk stratification was observed when echocardiographic LVH was taken into consideration: medium-risk patients decreased to 29% and high-risk patients rose to 56% (P<0.01). In conclusion, ultrasound assessment of cardiac target organ damage is extremely useful in obtaining a more valid assessment of global cardiovascular risk in elderly hypertensives, because stratification based on diagnostic routine procedures can underestimate the overall risk in a large fraction (48%) of medium-risk subjects.