[Do WHO-ISH guidelines identify high risk mild hypertensive patients?]

Area of Science:

• Cardiology
• Hypertension Management
• Clinical Guidelines Evaluation

Background:

• Mild hypertension management requires accurate risk stratification to guide treatment decisions.
• The 1993 World Health Organization-International Society of Hypertension (WHO-ISH) guidelines were developed to assist in identifying patients needing drug therapy.
• Assessing the effectiveness of existing guidelines is crucial for optimizing patient care and preventing unnecessary interventions.

Purpose of the Study:

• To evaluate the efficacy of the 1993 WHO-ISH recommendations in identifying hypertensive patients who require pharmacological treatment.
• To determine if the guidelines accurately differentiate between patients who would benefit from medication and those who would not.
• To assess the potential for over- or under-treatment based on the application of these specific hypertension guidelines.

Main Methods:

• A cohort of 123 patients with mild hypertension, meeting 1993 WHO-ISH criteria, underwent echocardiography and 10-year cardiovascular risk assessment using the Framingham equation.
• Patients were followed for six months with monthly blood pressure measurements and risk assessments by a physician blinded to echocardiographic results and risk calculations.
• Treatment decisions were made based on the physician's application of the WHO-ISH guidelines during the follow-up period.

Main Results:

• Drug treatment was initiated in 48 out of 118 patients. Treated patients were older and had higher left ventricular mass (LVM) than untreated patients, though few exceeded established LVM thresholds.
• Both stroke and coronary heart disease risks were significantly higher in the treated group compared to the untreated group (p < 0.05).
• The guidelines led to the undertreatment of some high-risk patients and potential overtreatment of low-risk individuals, with only 19 of 38 patients with <10% 10-year risk correctly identified, and 12 of 44 patients with <5% risk treated.

Conclusions:

• While differences in left ventricular mass (LVM) between treated and untreated patients lend some support to the WHO-ISH guidelines, LVM measurement provided limited individual patient management information.
• The 1993 WHO-ISH guidelines demonstrated limitations in accurately identifying patients at high risk for cardiovascular events.
• The study suggests that applying these guidelines may result in the over-treatment of patients with low cardiovascular risk, necessitating a re-evaluation of their clinical utility.