Change in cardiovascular risk profile by echocardiography in low- or medium-risk hypertension

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.