July 1, 2002Journal of Hypertension
Enhancing risk stratification in hypertensive subjects: how far should we go in routine screening for target organ damage?
Why the study?
Does intensive screening for target organ damage improve cardiovascular risk stratification in untreated hypertensive patients?
Population
Untreated hypertensive patients initially classified as low or medium absolute cardiovascular risk
Comparison
Intensive investigation for target organ damage vs Routine diagnostic procedures recommended by the…
Design
Editorial
Authors
Discussion
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Implication
Intensive screening for target organ damage using ultrasound and microalbuminuria significantly reclassifies cardiovascular risk in hypertensive patients, though widespread implementation requires further cost-benefit and primary care studies.
Structured PICO
Does intensive screening for target organ damage improve cardiovascular risk stratification in untreated hypertensive patients?
P
Population
Untreated hypertensive patients initially classified as low or medium absolute cardiovascular risk
I
Intervention
Intensive investigation for target organ damage (echocardiography, carotid ultrasound, and/or urinary albumin excretion with artificial neural network analysis)
C
Comparator
Routine diagnostic procedures recommended by the 1999 WHO-ISH guidelines (medical history, physical examination, routine blood chemistry, urine analysis, and ECG)
O
Outcome
Reclassification of absolute cardiovascular risk status to high or very high risksurrogate
Intensive screening for target organ damage using ultrasound and microalbuminuria significantly reclassifies cardiovascular risk in hypertensive patients, though widespread implementation requires further cost-benefit and primary care studies.
Limitations
- Patients drawn from specialized hospital-based clinics may not represent primary care populations
- Need for careful and detailed cost-benefit analysis
- Need for better linkage of intermediate endpoints to hard clinical endpoints through prospective longitudinal studies
- Requires widespread availability of high-quality procedures
Cite This Study
John Chalmers (2002) studied this question.