Key result
Evaluation using albuminuria, echocardiography, and carotid ultrasound detected target organ damage with sensitivities of 20%, 65%, and 41%, respectively, in primary hypertension.
Why the study?
Does the addition of microalbuminuria and cardiovascular ultrasonography to routine work-up improve risk stratification and cost-effectiveness in untreated primary hypertension?
Cross-Sectional (n=405)
Does the addition of microalbuminuria and cardiovascular ultrasonography to routine work-up improve risk stratification and cost-effectiveness in untreated primary hypertension?
The combined use of microalbuminuria testing and cardiovascular ultrasonography improves the detection of high-risk patients with primary hypertension, with microalbuminuria screening followed by ultrasound being the most cost-effective approach.
The aim of the present study is to assess the impact and cost-effectiveness of microalbuminuria and cardiovascular ultrasonography in evaluating risk profile in primary hypertension. Four-hundred and five untreated patients with primary hypertension underwent routine, traditional work-up plus evaluation of albuminuria and ultrasound assessment of cardiac and vascular structures. Albuminuria was measured as the albumin to creatinine ratio in three non consecutive first morning urine samples. Left ventricular mass index was assessed by MB-mode echocardiography and carotid intima-media thickness by high-resolution US scan. The impact of these tests on patient risk classes, as indicated by ESH-ESC guidelines, was assessed in light of their cost and sensitivity. The prevalence of microalbuminuria, left ventricular hypertrophy, and carotid intima-media thickening or plaque was 13%, 49%, and 32%, respectively. The combined use of albuminuria, cardiac, and vascular ultrasonography led to the detection of a significantly higher percentage of patients at high/very high risk. The three tests differ in sensitivity (albuminuria 20%, echocardiography 65%, and carotid ultrasound 41%). The signs of TOD only partly cluster within the same subgroup of patients and thus, all three tests should be performed in order to maximize the sensitivity of the evaluation process. The diagnostic algorithm yielding the lowest cost per detected case of TOD is the search for microalbuminuria followed by cardiac and carotid ultrasound assessment. In conclusion, ultrasonographic detection of TOD is a sensitive tool in the identification of high risk patients, but should be preceded by a routine search for microalbuminuria in order to optimize the cost-effectiveness of the diagnostic work-up. Am J Hypertens (2004) 17, 231A–231A; doi: 10.1016/j.amjhyper.2004.03.616
No takes yet. Share an insight, caveat, or question.
Francesca Viazzi (2004) conducted a cross-sectional in primary hypertension (n=405). Microalbuminuria and cardiovascular ultrasonography was evaluated on Detection of target organ damage and high/very high risk patients. Evaluation using albuminuria, echocardiography, and carotid ultrasound detected target organ damage with sensitivities of 20%, 65%, and 41%, respectively, in primary hypertension.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: