IMPACT OF 2007 ESH-ESC GUIDELINES ON CARDIOVASCULAR RISK STRATIFICATION IN PATIENTS WITH UNCOMPLICATED ESSENTIAL HYPERTENSION: PP.20.307

Abstract

Objective: Total cardiovascular risk determines decisions on treatment strategies in hypertensive patients. The 2007 ESH-ESC guidelines have proposed a new risk stratification scheme. The aim of the study was to assess cardiovascular risk in uncomplicated hypertensive patients comparing approaches of 2007 and 2003 ESH-ESC guidelines. Methods: In 576 non-diabetic essential hypertensive patients without established cardiovascular or renal disease (291 male, 53.0 ± 10.1 years (M ± SD), BMI 29.4 ± 4.4 kg/m2, 38% smokers, BP 156 ± 13/99 ± 8 mmHg, creatinine 94.3 ± 17.4 μmol/l, fasting plasma glucose 5.2 ± 0.6 mmol/l, LDL 3.7 ± 0.9 mmol/l, HDL 1.2 ± 0.3 mmol/l, TG 1.7 ± 0.7 mmol/l) blood chemistry and urine analysis, electrocardiogram, albumin/creatinine urine ratio, echocardiogram, carotid ultrasonogram, plethysmography or applanation tonometry were performed for assessment of total cardiovascular risk according both stratification schemes. Results: According to 2003 ESH-ESC guidelines 8.9, 36.1, 44.5 and 10.2% patients were considered at low, moderate, high and very-high added risk, respectively. Deletion of hsCRP >1 mg/dl from risk factors, taking into account ankle/brachial BP index <0.9 as organ damage (OD) had no significant impact on risk stratification. Use of new dyslipidemia criteria and taking into account signs of impaired carbohydrate metabolism resulted in 8.5 and 8.9% (p < 0.05 for each) increase of high/very high risk group. Equating of metabolic syndrome with OD increased high/very high risk group by 50.2% (p < 0.05). Use of carotid-femoral pulse wave velocity >12 m/s as OD and implementation of new criteria of subclinical kidney damage resulted in 15.4 and 56.4% (p < 0.05 for each) increase of high/very high risk patients. Conclusions: The 2007 ESH-ESC guidelines stratify a higher proportion of hypertensive patients in the high/very high risk groups than do 2003 guidelines. More than 80% uncomplicated hypertensive patients in outpatient hospital clinic have a high/very high added risk according to the 2007 ESH-ESC risk assessment approach. Re-classification of patients in high/very high group is mainly influenced by metabolic syndrome detection and implementation of decreased glomerular filtration rate or creatinine clearance as signs of subclinical organ damage.