Abstract
Decisions about the management of hypertensive patients should not be based on the level of blood pressure alone, but also on the presence of other risk factors, target organ damage and cardiovascular and renal disease. The results of echocardiography and carotid ultrasonography aids in the stratification of absolute cardiovascular risk as recently advocated by the guidelines of the European Society of Hypertension 2003. Therefore, the detection of target organ damage by ultrasound techniques allows an accurate identification of high-risk patients. Cardiovascular risk stratification only based on a simple routine work-up can often underestimate overall risk, thus leading to a potentially inadequate therapeutic management especially of low-medium risk patients.
Full text
PDF



Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Cuspidi Cesare, Ambrosioni Ettore, Mancia Giuseppe, Pessina Achille C., Trimarco Bruno, Zanchetti Alberto, APROS Investigators Role of echocardiography and carotid ultrasonography in stratifying risk in patients with essential hypertension: the Assessment of Prognostic Risk Observational Survey. J Hypertens. 2002 Jul;20(7):1307–1314. doi: 10.1097/00004872-200207000-00017. [DOI] [PubMed] [Google Scholar]
- European Society of Hypertension-European Society of Cardiology Guidelines Committee 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003 Jun;21(6):1011–1053. doi: 10.1097/00004872-200306000-00001. [DOI] [PubMed] [Google Scholar]
- Fox K. M., EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet. 2003 Sep 6;362(9386):782–788. doi: 10.1016/s0140-6736(03)14286-9. [DOI] [PubMed] [Google Scholar]
- Hillege Hans L., Fidler Vaclav, Diercks Gilles F. H., van Gilst Wiek H., de Zeeuw Dick, van Veldhuisen Dirk J., Gans Rijk O. B., Janssen Wilbert M. T., Grobbee Diederick E., de Jong Paul E. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation. 2002 Oct 1;106(14):1777–1782. doi: 10.1161/01.cir.0000031732.78052.81. [DOI] [PubMed] [Google Scholar]
- Levy D., Garrison R. J., Savage D. D., Kannel W. B., Castelli W. P. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990 May 31;322(22):1561–1566. doi: 10.1056/NEJM199005313222203. [DOI] [PubMed] [Google Scholar]
- Marques-Vidal P., Tuomilehto J. Hypertension awareness, treatment and control in the community: is the 'rule of halves' still valid? J Hum Hypertens. 1997 Apr;11(4):213–220. doi: 10.1038/sj.jhh.1000426. [DOI] [PubMed] [Google Scholar]
- Neal B., Anderson C., Chalmers J., MacMahon S., Rodgers A. Blood pressure lowering in patients with cerebrovascular disease: results of the PROGRESS (Perindopril Protection Against Recurrent Stroke Study) pilot phase. Clin Exp Pharmacol Physiol. 1996 May;23(5):444–446. doi: 10.1111/j.1440-1681.1996.tb02758.x. [DOI] [PubMed] [Google Scholar]
- Salonen J. T., Salonen R. Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. Arterioscler Thromb. 1991 Sep-Oct;11(5):1245–1249. doi: 10.1161/01.atv.11.5.1245. [DOI] [PubMed] [Google Scholar]
- Terpstra W. F., May J. F., Smit A. J., de Graeff P. A., Crijns H. J. G. M. Microalbuminuria is related to marked end organ damage in previously untreated, elderly hypertensive patients. Blood Press. 2002;11(2):84–90. doi: 10.1080/08037050211267. [DOI] [PubMed] [Google Scholar]
- Uemura K., Pisa Z. Trends in cardiovascular disease mortality in industrialized countries since 1950. World Health Stat Q. 1988;41(3-4):155–178. [PubMed] [Google Scholar]
- Vale Margarite J., Jelinek Michael V., Best James D., COACH study group. Coaching patients on Achieving Cardiovascular Health How many patients with coronary heart disease are not achieving their risk-factor targets? Experience in Victoria 1996-1998 versus 1999-2000. Med J Aust. 2002 Mar 4;176(5):211–215. doi: 10.5694/j.1326-5377.2002.tb04375.x. [DOI] [PubMed] [Google Scholar]
- Vasan R. S., Larson M. G., Leip E. P., Evans J. C., O'Donnell C. J., Kannel W. B., Levy D. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med. 2001 Nov 1;345(18):1291–1297. doi: 10.1056/NEJMoa003417. [DOI] [PubMed] [Google Scholar]
- Wachtell Kristian, Ibsen Hans, Olsen Michael H., Borch-Johnsen Knut, Lindholm Lars H., Mogensen Carl Erik, Dahlöf Björn, Devereux Richard B., Beevers Gareth, de Faire Ulf. Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study. Ann Intern Med. 2003 Dec 2;139(11):901–906. doi: 10.7326/0003-4819-139-11-200312020-00008. [DOI] [PubMed] [Google Scholar]
- Yusuf S., Sleight P., Pogue J., Bosch J., Davies R., Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. 2000 Jan 20;342(3):145–153. doi: 10.1056/NEJM200001203420301. [DOI] [PubMed] [Google Scholar]
- Zanchetti A., Mancia G. Benefits and cost-effectiveness of antihypertensive therapy. The actuarial versus the intervention trial approach. J Hypertens. 1996 Jul;14(7):809–811. doi: 10.1097/00004872-199607000-00001. [DOI] [PubMed] [Google Scholar]
