CAN ECHOCARDIOGRAPHY IDENTIFY MILDLY HYPERTENSIVE PATIENTS AT HIGH-RISK, LEFT UNTREATED BASED ON CURRENT GUIDELINES

Objective. To determine if the decision to treat uncomplicated mild hy pertension with drugs, in accordance with the WHO/ISH guidelines based on a series of blood pressure (BP) measurements over six months, resu lted in the treatment of patients at high risk, on the basis of echoca rdiography. Background. The value of echocardiography in mild hyperten sion management remains is unclear. Methods. One hundred and eighteen patients with mild hypertension (90 to 105 mmHg diastolic BP and/or 14 0 to 180 mmHg systolic BP) were examined by echocardiography at inclus ion and followed up for 6 months by a single physician unawere of the echographic results. Results. Drug treatment was given to 48 patients, and 70 remained untreated. Treated patients had higher echographic in dices than untreated patients (all p < 0.05): LV mass/body surface are a (82.8 +/- 15.9 vs 74.7 +/- 15.0 g/m2), interventricular septal thick ness (9.7 +/- 1.7 vs 8.5 +/- 1.3 mm), LV posterior wall thickness (8.4 +/- 1.1 vs 7.8 +/- 1.1 mm), relative wall thickness (0.37 +/- 0.06 vs 0.34 +/- 0.06). Left ventricular (LV) geometry was normal in 98 patie nts, and 20 had LV concentric remodeling. The 10-year coronary disease risk (Framingham equation) was higher in treated patients than in unt reated patients (10.0% vs 6.3%; p < 0.002), and in the 20 patients wit h concentric remodeling than in those with normal LV geometry (10.4%) vs 4.2%; p < 0.005). Nine of these 20 patients were still untreated at the end of the six-month follow-up period. Conclusion. Rigorous appli cation of the WHO-ISM clinical guidelines in a group of mild hypertens ive patients, led to the treatment of patients with slightly higher LV mass and more concentric LV geometry than were found in those not tre ated. However, a high-risk subgroup, with concentric remodeling, was n ot identified and left untreated.