Influence of target organ lesion detection (assessment of microalbuminuria and echocardiogram) in cardiovascular risk stratification and treatment of untreated hypertensive patients

Abstract

European guidelines indicate the importance of the evaluation of global cardiovascular risk (CVR) to determine the management of the hypertensive patients (EH). However, in primary care, the diagnostic work-up (PCD) only includes the metabolic risk factors. The aim of this study was to assess the importance of microalbuminuria (MA) and echocardiogram (ECHO) in the process of risk stratification, and the number of patients to be treated with drugs at diagnosis. In total, 155 nontreated EH were included in the study. Blood pressure, a lipid profile and plasma glucose (LG) were determined after an overnight fast. MA was evaluated with dipstick MICRALTEST, and in those patients with two positive results, it was measured again in two 24-h urine samples and was considered positive (MA þ ) if the average was 430 mg/24 h. Left ventricular mass index was calculated and values 4125 g/m 2 were considered as LV hypertrophy (LVH þ ). When the patients were stratified according to PCD, 22 had to be treated with drugs. When MA, ECHO and both tests used together were added to the risk evaluation, the number of patients to be treated were 42, 51 and 64, respectively (Po0.001 vs PCD). It is mainly in patients who have moderate cardiovascular risk that risk changes, whereas risk hardly changes in those having low and very high risk. In conclusion, in EH with moderate risk, measurement of MA, due to its easy availability and low cost, seems to be a cost effective screening test to avoid the underestimation of the CVR.

Cardiovascular risk profile and risk stratification of the hypertensive population attended by general practitioners and specialists in Spain. The CONTROLRISK study

“…32 For example, the measurement of microalbuminuria, is an easy and low-cost determination, according to 2003 ESH/ESC guidelines, and it seems to be a cost-effective screening test to avoid the underestimation of the CVR. 33 This underestimation of the risk probably implies that hypertensive patients could be frequently undertreated, what may have a critical influence in a poor BP control, mainly in high-risk groups. Moreover, these high-risk patients could also be denied of other beneficial interventions such as statins 34 on the basis of underestimation of the risk.…”

C-reactive protein and echocardiography have little impact on risk stratification in never-treated hypertensive patients

“…The only study we found about risk stratification in patients with hypertension using the 2003 guidelines found a somewhat more important role of echocardiography. 13 Differences in the determination of urinary albumin excretion (strips versus nephelometry), in the definition of left ventricular hypertrophy on ECG (adding Cornell Voltage product in our study) and in the prevalence of left ventricular hypertrophy on echocardiography are reasonable explanations for these discrepant findings.…”

“…It is difficult to explain the substantial differences in the prevalence of left ventricular hypertrophy between different studies. [9][10][11][12][13] Patient selection from a hypertension clinic in previous studies compared to a general medical outpatient clinic in the present study may be partially responsible. However, the prevalence of echocardiographic left ventricular hypertrophy in the present study is consistent with that recently reported in a general population sample.…”

“…However, the impact of echocardiographic left ventricular hypertrophy using the 2003 guidelines has been assessed in only one study. 13 Based on several studies showing an independent association of elevated high-sensitivity C-reactive protein (hsCRP) concentrations and cardiovascular events, 14,15 an hsCRP concentration above 10 mg/l has been added as an individual risk factor. However, the contribution of a greatly increased hsCRP to individual risk stratification as proposed by the 2003 guidelines has not been examined.…”

Assessment of metabolic profile in a clinical setting

“…Even high-normal albuminuria (10-20 mg/l) is an independent and early CVD risk factor [41]. Furthermore, patients with an albumin-to-creatinine ratio of 0.65 to 2.0 mg/mmol (a ratio of 2.0 mg/mmol indicates microalbuminuria) have more than twice the cardiovascular risk of patients with normal urinary albumin excretion rate (UAER) [42,43].…”