Why is cardiovascular risk stratification important in hypertensive patients?
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Updated: May 23, 2026

Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis
Published on: September 26, 2018
Gabriel Coll-De-Tuero1, Marc Saez, Antonio Rodriguez-Poncelas
1Primary Care, Health Care Institute, Parc Hospitalari Martí i Julià, Dr. Castany s/n, Salt, Girona, Spain. gabriel.coll@ias.scs.es
Insights
European Society of Hypertension guidelines effectively predict target organ damage progression in new hypertensive patients over one year. This risk stratification aids in managing cardiovascular health and preventing organ damage.
Area of Science:
- Cardiology
- Hypertension Management
- Preventive Medicine
Background:
- Cardiovascular risk stratification is crucial for managing newly diagnosed hypertensive patients.
- The European Society of Hypertension (ESH) guidelines provide a framework for risk assessment.
- Predicting the evolution of target organ damage (TOD) is essential for effective hypertension management.
Purpose of the Study:
- To evaluate if ESH guideline-based cardiovascular (CV) risk stratification predicts TOD evolution in newly diagnosed hypertensive patients.
- To assess the utility of routine clinical examinations in monitoring TOD over a 1-year period.
- To determine the predictive value of initial CV risk assessment on long-term TOD progression.
Main Methods:
- Prospective study of 479 newly diagnosed, untreated hypertensive patients.
- Evaluated urinary albumin excretion rate (UAER), blood analysis, electrocardiogram, retinography, and blood pressure (BP) at baseline and 1 year.
- Defined and assessed TOD evolution (favorable vs. unfavorable) based on ESH guidelines.
Main Results:
- Patients with low/moderate CV risk showed significantly less unfavorable TOD evolution compared to high/very high-risk groups.
- Specific findings include reduced rates of left ventricular hypertrophy (LVH), advanced fundus oculi (FO) damage, and high UAER in lower-risk patients.
- Adjusted odds ratios indicated a substantially higher likelihood of favorable TOD evolution for low/moderate CV risk patients across all TOD markers.
Conclusions:
- Routine clinical examinations are effective in detecting TOD variations in hypertensive patients within a 1-year follow-up.
- ESH guideline-derived CV risk stratification accurately predicts the 1-year evolution of target organ damage.
- This risk-based approach aids in proactive management and prevention of complications in hypertension.
Background:
The aim is to evaluate whether cardiovascular (CV) risk stratification in newly diagnosed hypertensive patients according to the European Society of Hypertension (ESH) guidelines, can predict the evolution of target organ damage (TOD) using routine examinations in clinical practice during 1 year.
Methods:
Prospective study of recently diagnosed untreated hypertensives. At the moment of inclusion and 1 year later, urinary albumin excretion rate (UAER), blood analysis, electrocardiogram, retinography, self-monitored blood pressure (BP) and ambulatory BP measurement were performed. TOD was defined following the ESH guidelines and evaluated as having favorable or unfavorable evolution.
Results:
Four hundred and seventy-nine hypertensive patients were included (58.8 years; 43.4% women). The baseline prevalence of TOD was: high UAER (2.4%), left ventricular hypertrophy (LVH) (20.7%), advanced lesion of the fundus oculi (FO) (10.2%). After 1 year, no differences were found between the final systolic and diastolic BP neither in the high/very high nor in the low/moderate CV risk groups. Patients with low/moderate CV risk had less unfavorable TOD evolution, LVH (9.2% vs 41.7%; p <0.001), FO advanced damage (0.99% vs 14.3%; p <0.001), high UAER (0.3% vs 5.1%; p <0.005) and amount of TOD (9.2% vs 44.0%; 0<0.001) than those with high/very high CV risk. The odds ratios of favorable TOD evolution adjusted for BP change and antihypertensive drug treatment were (low/moderate vs high/very high CV risk); 5.14 (95% confidence interval, CI, 3.99-6.64) for LVH; 12.42 (6.67-23.14) FO advanced damage; 10.71 (3.67-31.22) high UAER and 13.99 (10.18-19.22) for amount of TOD.
Conclusions:
It is possible to detect variations in TOD in hypertensive patients with a 1-year follow-up using the examinations available in routine clinic practice. The risk determined by the ESH guidelines predicts the evolution of TOD at 1 year.
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