The assessment of total cardiovascular risk in hypertensive subjects in primary care

Background. Recently published guidelines emphasize that detection of any subclinical target organ damage in hypertensive subjects should be regarded as a sign of high cardiovascular risk. Aim. To assess the ability of conventional multivariable cardiovascular disease risk prediction tools and high-sensitivity C-reactive protein (hs-CRP) to identify hypertensive subjects with target organ damage. Methods. Ankle-brachial index (ABI), estimated glomerular filtration rate (eGFR), electrocardiographically determined left ventricular hypertrophy (ECG-LVH), and base-line variables were measured in hypertensive subjects aged 45-70 years without established cardiovascular or renal disease or known diabetes. Results. Of the 495 subjects, 123 (24.8% (95% CI 21.1-28.9)) had ABI < 1.00, 81 (16.4% (95% CI 13.2-19.9)) had ECG-LVH, and 41 (8.3% (95% CI 6.0-11.1)) had eGFR < 60 mL/min/1.73 m<SU2</SU. In patients with SCORE < 5% or Framingham risk < 20%, any sign of target organ damage was found in 46% and 49% of patients, respectively. Conclusion. Assessment of ECG-LVH, ABI, and eGFR reclassifies a significant number of hypertensive patients to the high-risk category as compared to SCORE and Framingham risk prediction tools only.