Can echocardiography identify mildly hypertensive patients at high risk, left untreated based on current guidelines?

Objective To determine whether the decision to treat uncomplicated mild hyp ertension with drugs, in accordance with the World Health Organization - In ternational Society of Hypertension (WHO/ISH) guidelines based on a series of blood pressure (BP) measurements over 6 months, resulted in the treatmen t of patients at high risk on the basis of echocardiography. Methods One hundred and eighteen patients with mild hypertension (diastolic blood pressure 90-105 mmHg and/or systolic blood pressure 140-180 mmMg) we re examined by echocardiography at inclusion and followed up for 6 months b y a single physician unaware of the echographic results. Results Drug treatment was given to 48 patients, and 70 remained untreated. Treated patients had higher echographic indices than untreated patients (a ll P < 0.05): left ventricular (LV) mass/body surface area (83.0 +/- 15.6 v ersus 75.3 +/- 14.8 g/m(2)), inter-ventricular septal thickness (9.7 +/- 1. 7 versus 8.5 +/- 1.3 mm), LV posterior wall thickness (8.4 +/- 1.1 versus 7 .8 +/- 1.1 mm), relative wall thickness (0.37 +/- 0.06 versus 0.34 +/- 0.06 ). LV geometry was normal in 98 patients, and 20 had LV concentric remodell ing. The 10-year coronary disease risk (Framingham equation) was higher in the 20 patients with concentric remodelling than in those with normal LV ge ometry (10.4 versus 4.2%; P < 0.005). Nine of these 20 patients were still untreated at the end of the 6-month follow-hip period. Conclusion Rigorous application of the WHO/ISH clinical guidelines in a gro up of mild hypertensive patients led to the treatment of patients with slig htly higher LV mass and more concentric LV geometry than were found in thos e not treated. However, a high-risk subgroup, with concentric remodelling, was not identified and left untreated. J Hypertens 1999, 17:817-824 (C) Lip pincott Williams & Wilkins.