Risk reclassification in patients first contacting a doctor with uncomplicated hypertension

Abstract

Aim. To assess the changes of SCORE cardiovascular risk (CVR) in patients with hypertension (HTN) who first seek medical help taking into account target organ damage (TOD). Material and methods. The study included 300 men and women 40-65 years old with newly diagnosed HTN. All patients underwent a general physical examination, complaints and medical history taking with identifying risk factors; anthropometric examination; office blood pressure measurement; biochemical blood test; risk was determined on a SCORE scale. In order to identify TOD, echocardiography, duplex scanning of the brachiocephalic arteries, determination of microalbuminuria was conducted. Based on the results obtained, risk was determined taking into account the TOD. Results. The study showed that TOD was found in patients with different CVR status. In high-risk (HR) and very HR groups, the prevalence of TOD was 96,51% and 98,08%, respectively. Noteworthy is the high prevalence of TOD in the moderate risk (MR) group — 73,08%. TOD was also found in the low-risk (LR) group — 18,75%. The data obtained significantly changed the pattern of patients by CVR. The number of LR patients decreased from 10,32% to 8,67%. The number of very HR patients has not changed. The main changes were recorded in MR and HR groups: the number of MR patients decreased by 31,66%, while the number of HR patients increased by 36,7%. In 62,96% of LR and MR patients, there was CVR increase, and CVR pattern changed in HR patients increase. Conclusion. The results of the study show the expediency of creating a new standard for examining patients with uncomplicated hypertension who first seek medical help in the primary health care. This standard must be aimed to active diagnosis of subclinical TOD, which is an important element in determining of CVR group, and, consequently, developing adequate management strategy.