Echocardiography modified the risk classification in 29% of untreated low- or medium-risk hypertensive adults, identifying a need for immediate drug treatment.
Observational (n=792)
Yes
Does echocardiographic evaluation of left ventricular hypertrophy improve risk stratification in never-treated low- or medium-risk hypertensive adults?
Echocardiography frequently reclassifies low- and medium-risk hypertensive patients by detecting left ventricular hypertrophy, indicating a need for immediate pharmacological treatment.
BACKGROUND: Clinical decision-making in hypertensive patients is largely based upon assessment of total cardiovascular risk. World Health Organization-International Society of Hypertension (WHO-ISH) guidelines suggest delaying or withholding drug treatment in individuals assessed as at low risk on the basis of a suggested work-up that does not include echocardiography. OBJECTIVE: To assess the impact of echocardiography on risk stratification in never-treated individuals classified as at low cardiovascular risk. DESIGN: A retrospective analysis of a prospective survey. SETTING: Outpatient hypertension clinics of three community hospitals. PATIENTS: A total of 792 hypertensive adults classified as at low or medium risk, drawn from a larger sample of 1322 never-treated hypertensive patients. MAIN OUTCOME MEASURES: Change in risk class and need of immediate treatment after echocardiographic evaluation of left ventricular hypertrophy. RESULTS: Those at low and medium risk according to WHO-ISH (to receive delayed treatment) represented 17 and 43%, respectively, of the whole hypertensive population. The prevalence of left ventricular hypertrophy on echocardiography was 21 and 32% in low- and medium-risk groups, respectively (29% on average). CONCLUSIONS: In untreated hypertensive individuals without overt target-organ damage, in whom treatment would be postponed or avoided according to current WHO-ISH guidelines, echocardiography modifies the risk classification in 29% of the cases, identifying a need for immediate drug treatment. In low-risk untreated hypertensive individuals, echocardiography commonly alters risk stratification based on the initial WHO-ISH work-up.
Schillaci et al. (Thu,) conducted a observational in Hypertension (n=792). Echocardiography vs. WHO-ISH work-up without echocardiography was evaluated on Change in risk class and need of immediate treatment after echocardiographic evaluation of left ventricular hypertrophy. Echocardiography modified the risk classification in 29% of untreated low- or medium-risk hypertensive adults, identifying a need for immediate drug treatment.