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Intensive cardiovascular examination regarding blood pressure levels: evaluation of risk groups. ICEBERG study
Kemalettin Buyukozturk1, Baris Ilerigelen, Giray Kabakci
1Cardiology Department, Istanbul Medical School, Istanbul University, Istanbul, Turkey. buyukozturk@gediknet.com
Insights
Intensive cardiovascular examination, including echocardiography and carotid ultrasonography, improves risk stratification for hypertensive patients. Simple tests like microalbuminuria also enhance risk assessment beyond routine methods.
Area of Science:
- Cardiology
- Hypertension Management
- Diagnostic Accuracy
Background:
- Accurate cardiovascular risk assessment is vital for managing hypertension.
- The Intensive/Initial Cardiovascular Examination regarding Blood pressure levels: Evaluation of Risk Groups (ICEBERG) study addresses this need.
- Stratification of hypertensive patients into risk groups is essential for guiding treatment.
Purpose of the Study:
- To evaluate cardiovascular risk and stratify patients with high normal or high blood pressure (BP ≥ 130/85 mmHg).
- To assess the impact of laboratory tests and advanced imaging on cardiovascular risk stratification.
- To compare routine assessment with intensive examination methods.
Main Methods:
- An epidemiological study involving 10,313 patients with high blood pressure across 20 university hospitals and 197 primary care centers.
- Patients underwent routine clinical evaluation, with selected individuals receiving microalbuminuria (MAU), high-sensitivity C-reactive protein (hs-CRP) tests, echocardiography (Echo), and carotid ultrasonography (USG).
- Risk stratification followed the European Society of Hypertension/European Society of Cardiology Guidelines Committee (2003) into low, moderate, high, and very high added risk groups.
Main Results:
- Routine evaluation identified 51.2%–60.7% of patients in high/very high cardiovascular risk groups.
- Serum biochemistry increased this to 62.9%, and hs-CRP testing raised it to 76.2%.
- Microalbuminuria (MAU) testing led to a ~6% upward shift in risk category, echocardiography (Echo) a 4.9% shift, and carotid ultrasonography (USG) a 6.8% shift.
Conclusions:
- Intensive cardiovascular examination, incorporating echocardiography and carotid ultrasonography, offers more precise risk stratification for hypertensive patients.
- Microalbuminuria testing, a simple method usable in primary care, improves patient risk profiling compared to routine assessments alone.
- Advanced diagnostic tools enhance the accuracy of cardiovascular risk assessment in hypertensive individuals.
Objective:
Assessment of total cardiovascular risk level is crucial for approaching hypertensive patients. Therefore, the aim of the Intensive/Initial Cardiovascular Examination regarding Blood pressure levels: Evaluation of Risk Groups (ICEBERG) study is to determine cardiovascular risk evaluation and stratification of subjects with high normal and high blood pressure (BP > or = 130/85 mmHg), and to evaluate the impact of laboratory tests on this stratification.
Methods:
ICEBERG was an epidemiological study conducted at 20 university hospitals and 197 primary healthcare centers. A total of 10,313 patients, who were diagnosed with high BP and under antihypertensive treatment or not antihypertensive under treatment at least for the last 3 months were selected. Besides routine clinical evaluation, microalbuminuria (MAU) and high sensitive C-reactive protein (hs-CRP) tests, echocardiography (Echo) and carotid ultrasonography (USG) were performed in selected arms. The patients were stratified into low, moderate, high and very high added risk groups as described by the European Society of Hypertension/European Society of Cardiology Guidelines Committee (2003).
Results:
Upon routine evaluation, the percentage of "high and very high added cardiovascular risk" groups was between 51.2% and 60.7% in different study arms. This percentage increased to 62.9% by subsequent serum biochemistry assessment and to 76.2% by hs-CRP test results. Switching upwards to "high and very high added risk" groups was around 6% when MAU results were used, with a 4.9% upwards switch to "high and very high added risk" groups when Echo was performed; this proportion increased by 6.8%, when carotid USG was taken into account.
Conclusion:
Cardiovascular risk evaluation by intensive cardiovascular examination including Echo and carotid USG provided more accurate risk stratification. Furthermore, a simple test to demonstrate presence of MAU usable at primary healthcare level will also help to evaluate the patient's risk profile better than routine assessment methods alone.
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