Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

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

Journal of Human Hypertension volume 20, pages 187–192 (2006)Cite this article

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+) if the average was >30 mg/24 h. Left ventricular mass index was calculated and values >125 g/m2 were considered as LV hypertrophy (LVH+). 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 (P<0.001 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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Guidelines Committee. 2003 European Society of Hypertension–European Society of Cardiology guidelines for management of arterial hypertension. J Hypertens 2003; 21: 1011–1053.

  2. Devereaux RB, Reicheck W . Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation 1997; 55: 613–618.

    Article  Google Scholar 

  3. Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Gattobigio R, Zampi I et al. Prognostic significance of serial changes in left ventricular mass in essential hypertension. Circulation 1998; 97: 48–54.

    Article  CAS  PubMed  Google Scholar 

  4. Ogden LG, He J, Lydick E, Whelton PK . Long-term absolute benefit of lowering blood pressure in hypertensive patients according to the JNC VI risk stratification. Hypertension 2000; 35: 539–543.

    Article  CAS  PubMed  Google Scholar 

  5. Franch Nadal J, Álvarez Torices JC, Álvarez Guisasola F, Diego Dominguez F, Hernández Mejía R, Cueto Espinar A . Epidemiología de la diabetes mellitus en la provincia de León. Med Clin (Barc) 1992; 98: 607–611.

    CAS  Google Scholar 

  6. Castell C, Tresserras R, Serra J, Goday A, Lloveras G, Salleras LI . Prevalence of diabetes in Catalonia (Spain): an oral glucose tolerance test-based population study. Diab Res Clin Practice 1999; 43: 33–40.

    Article  CAS  Google Scholar 

  7. Goday A . Epidemiología de la diabetes y sus complicaciones no coronarias. Rev Esp Cardiol 2002; 55: 657–670.

    Article  PubMed  Google Scholar 

  8. García-Puig J, Ruilope LM, Luque M, Fernández J, Ortega R, Dal-Ré R . Prevalence of carbohydrate metabolic alterations in hospital-based hypertension units in Spain: the AVANT study. J Hypertens 2004; 22 (Suppl 1): 97s.

    Article  Google Scholar 

  9. Salmasi A, Alimo A, Dancy M . Prevalence of unrecognized abnormal glucose tolerance in patients attending a hospital hypertension clinic. Am J Hypertens 2004; 17: 483–488.

    Article  CAS  PubMed  Google Scholar 

  10. The Seventh Report of the Joint national Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The JNC VII report. JAMA 2003; 289: 2560–2572.

  11. Viazzi F, Parody D, Leoncini G, Vettoretti S, Ratto E, Vaccaro V et al. Optimizing global risk evaluation in primary hypertension: the role of microalbuminuria and cardiovascular ultrasonography. J Hypertens 2004; 22: 907–913.

    Article  CAS  PubMed  Google Scholar 

  12. Schillaci G, De Simone G, Reboldi G, Porcellati C, Devereux RB, Verdecchia P . Change in cardiovascular risk profile by echocardiography in low-or medium-risk hypertension. J Hypertens 2002; 20: 1519–1525.

    Article  CAS  PubMed  Google Scholar 

  13. Cuspidi C, Michev L, Severgnini B, Meani S, Fusi V, Valerio C et al. Change in cardiovascular risk profile by echocardiography in medium-risk elderly hypertensives. J Hum Hypertens 2003; 17: 101–106.

    Article  CAS  PubMed  Google Scholar 

  14. Cerasola G, Mule G, Nardi E, Cottone S, Andronico G, Mongiovi R et al. Usefulness of microalbuminuria in cardiovascular risk stratification of essential hypertensive patients. Nephron Clin Pract 2004; 96 (4): 123–130.

    Article  Google Scholar 

  15. Martínez AM, Sancho T, Armada E, Rubio JM, Antón JL, Torre A et al. Prevalence of left ventricular hypertrophy in patients with mild hypertension in primary care: impact of echocardiography on cardiovascular risk stratification. Am J Hypertens 2003; 16: 556–563.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hypertension Unit, Hospital Clinico San Carlos, Madrid, Spain

    M Luque, B de Rivas, B Alvarez, G Garcia, C Fernandez & N Martell

Authors
  1. M Luque
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B de Rivas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B Alvarez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G Garcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C Fernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. N Martell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M Luque.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Luque, M., de Rivas, B., Alvarez, B. et al. Influence of target organ lesion detection (assessment of microalbuminuria and echocardiogram) in cardiovascular risk stratification and treatment of untreated hypertensive patients. J Hum Hypertens 20, 187–192 (2006). https://doi.org/10.1038/sj.jhh.1001971

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1001971

Keywords

This article is cited by

Search

Advanced search

Quick links