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.