Prevalence of left ventricular hypertrophy in patients with mild hypertension in primary care: impact of echocardiography on cardiovascular risk stratification

Martínez, María Antonia; Sancho, Teresa; Armada, Eduardo; Rubio, José M.; Antón, J.; Torre, Alberto Miján de la; Palau, Javier; Seguido, Paloma; Gallo, Jaime; Sáenz, Isabel; Polo, Enrique; Torres, Rosa J.; Oliver, Josè M.; Puig, Juan

doi:10.1016/s0895-7061(03)00859-8

Cited by 56 publications

(37 citation statements)

References 34 publications

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“…1 K The usual evaluation of these patients in primary health care does not include the assessment of target organ damage. 15 What this study adds K The routine evaluation of CVR carried out in Primary Health Care (PHC) may lead to underestimating the risk of hypertensive patients, classifying many of them with a CVR lower than that corresponding to them. K In the present study, with the usual approach performed in PHC, drug treatment should have been initiated in 22 patients (14.1%).…”

Section: Discussionmentioning

confidence: 99%

“…K Those patients who, after this first assessment, have a low and above all moderate CVR should be measured for MA as a first evaluation of the presence of target organ damage, since this is an easy to perform and cost-effective test within the reach of all PHC professionals. 15 who found that the performance of an ECHO may be especially useful in patients who, after an initial assessment that included MA, were classified as having moderate CVR. In this group, 40% were reclassified to high risk according to the ECHO results.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2005

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2005

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“…2,14 Moreover, left ventricular mass is considered a risk factor of stroke. 5,[15][16][17] However, the effect of the interaction between physical activity and LVH on the risk of stroke has rarely been investigated. In a recent case-control study, Rodriguez et al 5 observed a significant association between increased left ventricular mass and physical activity.…”

Section: Discussionmentioning

confidence: 99%

Physical activity decreases the risk of stroke in middle-age men with left ventricular hypertrophy: 40-year follow-up (1961–2001) of the Seven Countries Study (the Corfu cohort)

et al. 2004

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Left ventricular hypertrophy (LVH) is a dominant characteristic of cardiovascular mortality. We investigated the interaction between physical activity and LVH on stroke mortality, based on a 40-year follow-up of the Corfu cohort from the Seven Countries Study. The population studied consisted of 529 rural men (40-59 years old) enrolled in the Study at 1961. LVH was electrographically confirmed according to Minnesota coding. Physical activity levels were assessed by selfreports of habitual, occupational and leisure-time activities. Cox proportional hazard models were used to evaluate exercise levels with respect to stroke mortality in people with and without LVH. During the follow-up, 461 (87%) died, and 74 (16%) of these deaths were due to stroke. LVH was present in 40 (7.5%) men. A total of 362 (68%) men were defined as physically active. Physical activity was associated with a lower risk of stroke (hazard ratio ¼ 0.65, Po0.05). On the other hand, LVH had 5.8-fold the risk of stroke (Po0.001) among sedentary and 4.5-fold the risk (Po0.001) among physically active men, after controlling for several potential confounders. However, moderate physical activity decreased the risk of stroke by 49% in men with LVH as compared to sedentary without LVH (hazard ratio ¼ 0.51, Po0.01), while hard exercise did not confer any significant reduction in stroke risk. We revealed the benefits from moderate physical activity on stroke mortality among men with LVH. Physicians and other health-care professionals should encourage patients with LVH to adopt a physically active lifestyle.

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“…The enlargement of individual myocytes in LV has been considered an adaptation to increased blood pressure. However, non-hemodynamic factors may also be involved in the pathogenesis of LVH since it can be found in patients with only mild hypertension (Martinez et al, 2003). Cardiac hypertrophy has been studied using 3 representative models: aortic coarctation, monolayer cells cultured on stretchable mesh, and cardiac myocyte culture stimulated with different trophic factors.…”

Section: Discussionmentioning

confidence: 99%

Gene expression in uremic left ventricular hypertrophy: effects of hypertension and anemia

Mak

Chang²,

Draksharapu³

et al. 2004

Exp Mol Med

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Prevalence of left ventricular hypertrophy in patients with mild hypertension in primary care: impact of echocardiography on cardiovascular risk stratification

Cited by 56 publications

References 34 publications

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

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

Physical activity decreases the risk of stroke in middle-age men with left ventricular hypertrophy: 40-year follow-up (1961–2001) of the Seven Countries Study (the Corfu cohort)

Gene expression in uremic left ventricular hypertrophy: effects of hypertension and anemia

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