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[Can echocardiography identify mildly hypertensive patients at high risk, left untreated, based on current
E Abergel1, G Chatellier, C Battaglia
1Centre de médecine préventive cardio-vasculaire, Paris.
Insights
Echocardiography in mild hypertension management revealed that drug treatment was given to patients with higher left ventricular mass and concentric geometry. However, a high-risk subgroup with concentric remodeling was undertreated, indicating a gap in current guidelines.
Area of Science:
- Cardiology
- Hypertension Management
- Diagnostic Imaging
Background:
- The role of echocardiography in managing mild hypertension is not well-established.
- Current guidelines for mild hypertension treatment may not fully identify high-risk individuals.
Purpose of the Study:
- To assess if current guidelines for treating mild hypertension lead to the identification and treatment of high-risk patients using echocardiography.
- To evaluate the effectiveness of echocardiography in risk stratification for mild hypertension.
Main Methods:
- One hundred eighteen patients with mild hypertension were assessed using echocardiography.
- Patients were followed for six months, with treatment decisions based on WHO/ISH guidelines and blood pressure measurements.
- Echocardiographic indices and 10-year coronary disease risk were analyzed.
Main Results:
- Treated patients exhibited significantly higher left ventricular (LV) mass and more concentric LV geometry compared to untreated patients.
- Patients with LV concentric remodeling had a higher 10-year coronary disease risk than those with normal LV geometry.
- A subgroup of 20 patients with concentric remodeling showed elevated coronary disease risk, with nine remaining untreated.
Conclusions:
- Strict adherence to WHO-ISH guidelines for mild hypertension resulted in treating patients with slightly increased LV mass and concentric geometry.
- The study identified a high-risk subgroup with concentric remodeling that was undertreated, suggesting limitations in current guidelines.
- Echocardiography can provide valuable risk stratification in mild hypertension, but current guidelines may not fully capture all high-risk individuals.
Objective:
To determine if the decision to treat uncomplicated mild hypertension with drugs, in accordance with the WHO/ISH guidelines based on a series of blood pressure (BP) measurements over six months, resulted in the treatment of patients at high risk, on the basis of echocardiography.
Background:
The value of echocardiography in mild hypertension management remains is unclear.
Methods:
One hundred and eighteen patients with mild hypertension (90 to 105 mmHg diastolic BP and/or 140 to 180 mmHg systolic BP) were examined by echocardiography at inclusion and followed up for 6 months by a single physician unaware of the echographic results.
Results:
Drug treatment was given to 48 patients, and 70 remained untreated. Treated patients had higher echographic indices than untreated patients (all p < 0.05): LV mass/body surface area (82.8 +/- 15.9 vs 74.7 +/- 15.0 g/m2), interventricular septal thickness (9.7 +/- 1.7 vs 8.5 +/- 1.3 mm). LV posterior wall thickness (8.4 +/- 1.1 vs 7.8 +/- 1.1 mm), relative wall thickness (0.37 +/- 0.06 vs 0.34 +/- 0.06). Left ventricular (LV) geometry was normal in 98 patients, and 20 had LV concentric remodeling. The 10-year coronary disease risk (Framingham equation) was higher in treated patients than in untreated patients (10.0% vs 6.3%; p < 0.002), and in the 20 patients with concentric remodeling than in those with normal LV geometry (10.4%) vs 4.2%; p < 0.005). Nine of these 20 patients were still untreated at the end of the six-month follow-up period.
Conclusion:
Rigorous application of the WHO-ISH clinical guidelines in a group of mild hypertensive patients, led to the treatment of patients with slightly higher LV mass and more concentric LV geometry than were found in those not treated. However, a high-risk subgroup, with concentric remodeling, was not identified and left untreated.