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World Health Organization cardiovascular risk stratification and target organ damage
D Piskorz1, L Bongarzoni2, L Citta2
1Instituto de Cardiología, Sanatorio Británico SA, Paraguay 40, 2000 Rosario, Argentina; Centro de Investigaciones Cardiovasculares, Sanatorio Británico SA, Paraguay 40, 2000 Rosario, Argentina.
Insights
Screening for asymptomatic target organ damage in hypertensive patients is crucial. This damage is more frequent and severe as cardiovascular risk increases, potentially misclassifying over a quarter of patients.
Area of Science:
- Cardiology
- Hypertension Management
- Preventive Medicine
Background:
- Cardiovascular risk prediction charts guide treatment but often omit screening for asymptomatic target organ damage.
- This omission can significantly alter patient risk assessment and management strategies.
Purpose of the Study:
- To investigate the presence and severity of target organ damage in hypertensive patients across different cardiovascular risk strata.
- To demonstrate that target organ damage is more prevalent and severe with increasing global cardiovascular risk.
Main Methods:
- A cohort of 292 consecutive hypertensive patients was analyzed.
- Cardiovascular risk was stratified using the 2013 WHO/ISH risk prediction chart.
- Left ventricular hypertrophy (LVH), diastolic dysfunction (E/e' ratio), and systolic function (s wave) were assessed using echocardiography and tissue Doppler imaging.
Main Results:
- Left ventricular hypertrophy was found in 17.6% of low-risk, 27.8% of medium-risk, and 23.3% of high-risk patients (p<0.05).
- Abnormal diastolic function (E/e' ratio >13) was present in 13.8% (low), 31.1% (medium), and 27.9% (high) risk groups (p<0.05).
- Systolic function (s wave) showed significant differences across risk groups (p<0.025).
Conclusions:
- Target organ damage, including LVH and diastolic dysfunction, is more frequent and severe in hypertensive patients with higher cardiovascular risk.
- Asymptomatic target organ damage led to misclassification in over 25% of patients, highlighting the need for comprehensive screening.
Background:
Prediction charts allow treatment to be targeted according to simple markers of cardiovascular risk; many algorithms do not recommend screening asymptomatic target organ damage which could change dramatically the assessment.
Objective:
To demonstrate that target organ damage is present in low cardiovascular risk hypertensive patients and it is more frequent and severe as global cardiovascular risk increases.
Methods:
Consecutive hypertensive patients treated at a single Latin American center. Cardiovascular risk stratified according to 2013 WHO/ISH risk prediction chart America B. Left ventricular mass assessed by Devereux method, left ventricular hypertrophy considered >95g/m(2) in women and >115g/m(2) in men. Transmitral diastolic peak early flow velocity to average septal/lateral peak early diastolic relaxation velocity (E/e' ratio) measured cut off value >13. Systolic function assessed by tissue Doppler average interventricular septum/lateral wall mitral annulus rate systolic excursion (s wave).
Results:
A total of 292 patients were included of whom 159 patients (54.5%) had cardiovascular risk of <10%, 90 (30.8%) had cardiovascular risk of 10-20% and 43 (14.7%) had cardiovascular risk of >20%. Left ventricular hypertrophy was detected in 17.6% low risk patients, 27.8% in medium risk and 23.3% in high risk (p<0.05), abnormal E/e' ratio was found in 13.8%, 31.1% and 27.9%, respectively (p<0.05). Mean s wave was 8.03+8, 8.1+9 and 8.7+1cm/s for low, intermediate and high risk patients, respectively (p<0.025).
Conclusions:
Target organ damage is more frequent and severe in high risk; one over four subjects was misclassified due to the presence of asymptomatic target organ damage.
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