Global Cardiovascular Risk Profile Research Articles

Carotid Intima-Media Thickness and Its Correlation With Echocardiographic Left Ventricular Function and Geometry in Hypertensive Individuals: A Cross-Sectional Study.

Background It is important to consider left ventricular hypertrophy (LVH) and carotid intima-media thickness (CIMT) in assessing hypertensive patients' global cardiovascular risk profile, as LVH and arterial wall changes occur concurrently. This study aimed to assess the relationship between CIMT and left ventricular geometry and function in hypertensive patients. Methodology This cross-sectional study included 200 hypertensive individuals and sought to correlate their CIMT with left ventricular geometry and function in Lagos University Teaching Hospital. Hypertension was defined as blood pressure ≥140/90 mmHg or on treatment for hypertension presenting at the outpatient clinics. Patients who satisfied the inclusion criteria were recruited. Abnormal CIMT was defined as >0.9 mm. Patients' demographic data were obtained in addition to general characteristics, physical examination, transthoracic echocardiography, and CIMT. The statistical relationship between CIMT and left ventricular geometry and function was obtained and analyzed. Results Normal geometry and LVH were observed in 50.5% and 15.5%, respectively. Left ventricular geometry was associated with abnormal CIMT (χ2 = 31.688, p < 0.001). Furthermore, the mean left ventricular mass index was statistically different between abnormal and normal CIMT (97.84 ± 30.5 vs. 80.75 ± 15.6; p < 0.001). Regardingleft ventricular function, there was no significant difference in E-point septal separation, left ventricular fractional shortening, and left ventricular ejection fraction in abnormal versus normal CIMT groups. However, there was a significant association of CIMT with grades of diastolic dysfunction (χ2 = 7.069, p = 0.029). Additionally, individual parameters of diastolic dysfunction such as left atrial volume index and septal mitral were significantly different (p < 0.001). Conclusions There was an association between age, left ventricular geometry, diastolic function, and CIMT in hypertensive individuals. Therefore, it is beneficial to evaluate CIMT and for these patients to receive more targeted blood pressure control which may reduce the risk of cardiovascular diseases.

Global Cardiovascular Risk Profile and Cerebrovascular Abnormalities in Presymptomatic Individuals with CADASIL or Autosomal Dominant Alzheimer's Disease.

Cardiovascular risk factors increase the risk of developing dementia, including Alzheimer's disease and vascular dementia. Studying individuals with autosomal dominant mutations leading to the early onset of dementia, this study examines the effect of the global cardiovascular risk profile on early cognitive and neuroimaging features of Alzheimer's disease and vascular dementia. We studied 85 non-demented and stroke-free individuals, including 20 subjects with Presenilin1 (PSEN1) E280A mutation leading to the early onset of autosomal dominant Alzheimer's disease (ADAD), 20 subjects with NOTCH3 mutations leading to cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and to the early onset of vascular dementia, and 45 non-affected family members (non-carriers). All subjects underwent clinical and neuropsychological evaluations and an MRI. The global cardiovascular risk profile was estimated using the office-based Framingham Cardiovascular Risk Profile (FCRP) score. In individuals with CADASIL, a higher FCRP score was associated with a reduced hippocampal volume (B = -0.06, p < 0.05) and an increased severity of cerebral microbleeds (B = 0.13, p < 0.001), lacunes (B = 0.30, p < 0.001), and perivascular space enlargement in the basal ganglia (B = 0.50, p < 0.05). There was no significant association between the FCRP score and neuroimaging measures in ADAD or non-carrier subjects. While the FCRP score was related to performance in executive function in non-carrier subjects (B = 0.06, p < 0.05), it was not significantly associated with cognitive performance in individuals with CADASIL or ADAD. Our results suggest that individuals with CADASIL and other forms of vascular cognitive impairment might particularly benefit from early interventions aimed at controlling cardiovascular risks.

Global Cardiovascular Risk Profile of Italian Medical Students Assessed by a QR Code Survey. Data from UNIMI HEART SURVEY: Does Studying Medicine Hurt?

Background: Few studies to date have addressed global cardiovascular (CV) risk profile in a “protected” young population as that of medical school students. Objective: to assess CV traditional risk factors and global CV risk profile of Italian medical students throughout the six years of university. Methods: A cross-sectional survey accessible online via quick response (QR) code was conducted among 2700 medical students at the University of Milan, Italy. Data on baseline characteristics, traditional CV risk factors, diet, lifestyle habits, and perceived lifestyle variations were evaluated across different years of school. Results: Overall, 1183 students (mean age, 22.05 years; 729 women (61.6%)) out of 2700 completed the questionnaire (43.8% rate response). More than 16% of the students had at least 3 out of 12 CV risk factors and only 4.6% had ideal cardiovascular health as defined by the American Heart Association. Overweight, underweight, physical inactivity, sub-optimal diet, smoke history, and elevated stress were commonly reported. Awareness of own blood pressure and lipid profile increased over the academic years as well as the number of high-blood-pressure subjects, alcohol abusers, and students constantly stressed for university reasons. Moreover, a reduction in physical-activity levels over the years was reported by half of the students. Conclusion and Relevance: This study demonstrates that a “protected” population as that of young medical students can show an unsatisfactory cardiovascular risk profile and suggests that medical school itself, being demanding and stressful, may have a role in worsening of the lifestyle.

The return of renal denervation for the treatment of hypertension: an update on new evidence and clinical indications

Improved and durable control of hypertension is a global priority for healthcare providers and policymakers. Despite all the efforts, hypertension is still misdiagnosed in half of hypertensive patients and poor drug adherence, reaching half of drug-treated patients, represents the major cause of uncontrolled hypertension. Initial studies on renal denervation (RDN) for the treatment of uncontrolled resistant hypertension produced conflicting results. A new generation of randomized clinical trials has shown promising results with new-generation devices in various hypertensive populations. From uncontrolled-resistant hypertension, the target population for RDN has moved to difficult-to-treat or resistant hypertensive patients. The selection process should take into account not only blood pressure values and the global cardiovascular risk profile, but also drug adherence and tolerability and patient preferences. The following is a state-of-the-art review of current studies and an analysis of the characteristics of hypertensive patients that could benefit from RDN.

Italian Society of Arterial Hypertension (SIIA) Position Paper on the Role of Renal Denervation in the Management of the Difficult-to-Treat Hypertensive Patient.

Renal denervation is a device-based procedure for hypertension for which safety and efficacy has been demonstrated. At present, its clinical use is still matter of debate, despite the most recent clinical trials have shown promising results with new-generation devices in various hypertensive populations. This position paper was deemed necessary by the Italian Society of Arterial Hypertension, in order to provide indications about the applications of renal denervation in the clinical setting. A state-of-the art review of the literature, focusing on safety and efficacy data, is provided. Furthermore, based on current evidence and expert consensus, clinical profiles of possible candidates for renal denervation are proposed. The selection process should take into account not only blood pressure values, global cardiovascular risk profile, but also drug adherence and tolerability and patient preferences. This position paper also defines minimum requirements for renal denervation selection centers and a flowchart for the difficult-to-treat hypertensive patient. Further studies are needed to support these preliminary indications, which are based on expert-consensus only.

Effects of a Novel Fixed Combination of Nutraceuticals on Serum Uric Acid Concentrations and the Lipid Profile in Asymptomatic Hyperuricemic Patients : Results from the PICONZ-UA Study.

Asymptomatic hyperuricemia is not a current indication for therapy as the definite role of serum uric acid elevation as a cardiovascular risk factor is extremely likely but still controversial. We designed a double blind, placebo-controlled, randomized study to assess the effects of a combination of nutraceuticals (ZinutriK®, containing a fixed combination of kampferol, baicalin, caffeine, and rutin) on serum uric acid levels, lipid variables and the global cardiovascular risk profile. Sixteen individuals (mean age 59.0±11.9years, 4 women) with asymptomatic hyperuricemia completed the study. ZinutriK® treatment (4weeks) reduced serum uric acid concentrations (from 7.9+0.9 to 7.0+0.7mg/dL) when compared to both baseline and placebo (p<0.006 and p<0.001, respectively). Compared to both placebo and baseline, the same fixed combination of nutraceuticals also reduced circulating LDL cholesterol and increased HDL cholesterol concentrations within 4weeks (p<0.001 or less), thereby improving the Framingham risk score (p<0.001 or less). Neither minor nor major side effects were observed. This study represents the first demonstration that a short-term therapy with a fixed combination of different natural substances can significantly reduce serum uric acid concentrations in asymptomatic hyperuricemic patients, with no side effects and a significant improvement in the lipid pattern and then in the global cardiovascular risk profile.

Improving cardiovascular prevention in general practice: Results of a comprehensive personalized strategy in subjects at high risk.

Although high cardiovascular risk patients should be the main target of preventive strategies, modifiable risk factors are often inadequately controlled. To assess feasibility and results of a comprehensive personalized method for cardiovascular prevention in high risk patients followed by their general practitioner. Between 2004 and 2007, 12,513 patients (mean age 64.0 ± 9.5 years; 61.5% males) with multiple cardiovascular risk factors or history of atherosclerotic disease were identified and followed for five years. If control of major modifiable cardiovascular risk factors (hypertension, hypercholesterolaemia, diabetes, obesity, smoking, unhealthy diet, physical inactivity) was sub-optimal, at baseline and yearly thereafter general practitioners planned with patients, with the help of a brief checklist, preventive interventions to improve the global risk profile. Main outcome was the control of the seven major modifiable cardiovascular risk factors during follow-up. Secondary outcome was the incidence of cardiovascular deaths and hospitalization for cardiovascular reasons according to the improvement in global cardiovascular risk profile during the first year. Control of all major modifiable risk factors except physical inactivity improved gradually and significantly (p < 0.0001) during follow-up.The improvement in the global cardiovascular risk profile during the first year was independently and significantly associated with a lower rate of major cardiovascular events in the following years (hazard ratio 0.939; 95% confidence interval 0.887-0.994, p = 0.03). Our comprehensive, personalized method for cardiovascular risk prevention in people at high risk appears feasible in general practice. The improvement in the global cardiovascular risk profile was associated with a better prognosis.

Global cardiovascular risk profiles of untreated hypertensives in an urban, developing community in Africa

Blood pressure (BPR) control in people of African descent is poor, largely because of a lack of treatment. Although the requirements for immediate initiation of antihypertensive drug therapy are defined by global cardiovascular risk, the global cardiovascular risk profiles of untreated hypertensives at a community level are uncertain. To identify the distribution of global cardiovascular risk profiles of untreated hypertensives in an urban, developing community of African descent in South Africa. As part of the African Programme on Genes in Hypertension, we assessed nurse-derived clinic BP (the mean of five standardised BP values obtained according to guidelines), current antihypertensive therapy, and total cardiovascular risk in 1 029 participants older than 16 years of age from randomly selected nuclear families from the South West Township of Gauteng (SOWETO). Approximately 46% of participants had systolic/ diastolic BP values ≥ 140/90 mmHg and ∼23% of participants were hypertensives not receiving antihypertensive medication. Approximately 12% of untreated hypertensives had a high added risk and ∼18% a very high added risk (6.7% of the total sample). In untreated hypertensives, in contrast to the absence of severe hypertension and diabetes mellitus in those with lower risk profiles, a high cardiovascular risk profile in this group was characterised by severe hypertension in ∼52% and diabetes mellitus in ∼33%. Based on a high added risk carrying at least a 20% chance and a very high added risk at least a 30% chance of a cardiovascular event in 10 years, this translates into 1 740 events per 100 000 of the population within 10 years, events that could be prevented through antihypertensive drug therapy. In an urban, developing community of African ancestry, a significant proportion (6.7%) of people may have untreated hypertension and a global cardiovascular risk profile that suggests a need for antihypertensive drug therapy. Cardiovascular risk in this group is driven largely by the presence of severe hypertension or diabetes mellitus.

2007 ESH/ESC Guidelines for the management of hypertension, from theory to practice: global cardiovascular risk concept

Clinical evaluation of cardiovascular risk in patients with hypertension is evolving from independently assessing well-known, traditional risk factors (e.g. hypertension, hypercholesterolemia, obesity, diabetes mellitus, smoking) towards an integrated, multidisciplinary clinical approach, aimed at determining the global (or total) cardiovascular risk profile in each individual patient for planning early and effective strategies for cardiovascular prevention. A paradigmatic example is provided by hypertension, in which new clinical behaviour implies a shift from focusing only on high blood pressure levels towards a more integrated approach, aimed at identifying and reducing global cardiovascular risk, as is highlighted in the European Guidelines. This approach arises from the acknowledgement that a cluster of cardiovascular risk factors is the rule, rather than the exception in hypertension. In addition, major cardiovascular diseases often develop from a subclinical level, which can be discovered at an early stage, thus providing the opportunity promptly to intercept and treat high-risk patients early. Identification of organ damage and assessment of hypertension-related clinical conditions can further contribute to a more precise definition of an individual total cardiovascular risk profile, and to the decision on when, how and how much to treat patients with hypertension. Implementing a clinical behaviour based on global cardiovascular risk assessment will help to target global cardiovascular risk reduction, while maintaining specific therapeutic goals for individual risk factors. This synergistic approach holds the best promise for treating total cardiovascular risk and reducing the mounting global burden of cardiovascular disease associated with hypertension.

Global Cardiovascular Risk Assessment in Different Clinical Settings

Background: Cardiovascular diseases still represent the leading cause of morbidity and mortality, worldwide. Early detection and appropriate management of major cardiovascular risk factors in clinical practice may improve preventive strategies in Western countries, including Italy. Objective: To evaluate the prevalence of major cardiovascular risk factors and their impact on routine clinical practice of Italian general practitioners (GPs), cardiologists and diabetologists. Methods: The study involved physicians who participated in an educational project on cardiovascular risk management, the EFFECTUS (Evaluation of Final Feasible Effect of Control Training and UltraSensitisation) programme. Physicians were asked to report data already available in their clinical records of the first ten consecutive adult outpatients during May 2006. Data collection included patients’ full medical history and therapies, physical examination (anthropometric parameters and blood pressure levels), laboratory results and diagnostic examinations. Data were then centrally analysed for global cardiovascular risk evaluation and cardiovascular risk profile characterization. The present study provides data from the baseline records of the EFFECTUS programme. Results: A total of 1078 physicians (73% males and 27% females, mean age 50 – 7 years), of which 841 (78%) were GPs, 140 (13%) cardiologists and 97 (9%) diabetologists, included data from 9904 outpatients (5300 males and 4604 females, mean age 67 – 9 years). In the overall population, 2504 (25%) subjects were obese, 7436 (75%) had hypertension, 5873 (59%) had dyslipidaemia, 3681 (37%) had diabetes mellitus and 2633 (27%) had a history of ischaemic heart disease, while 1102 (11%) and 1247 (13%) had cerebral or peripheral artery disease, respectively. Significant differences were reported in the prevalence of detected cardiovascular risk factors among physicians operating in different clinical settings. Moreover, different clinical habits were recorded.

β-Blockers and Diuretics in the Treatment of Hypertension

In a recent issue of High Blood Pressure and Cardiovascular Prevention, a very interesting debate on the clinical and prognostic significance of new-onset diabetes mellitus in hypertension was held by Prof. M.H. Alderman and Prof. P. Verdecchia. Beside the major objectives of the debate, both authors included in their discussion references to the potential influence of antihypertensive treatments on susceptibility to diabetes development. Indeed, in the last few years, especially after the introduction of this treatment as a secondary or additive endpoint in interventional clinical trials on hypertension, new-onset diabetes has raised the interest of physicians, and actually represents a ‘hot topic’ in the global cardiovascular risk profile and consequent therapeutic management in hypertension.The following editorial provides some element of discussion. Obviously, it cannot be conclusive, although it may stimulate active and direct investigation on this aspect, which can have a major influence on healthcare systems expenditure, given the uprising prevalence of hypertension and the mounting prognostic importance of diabetes in the adult and elderly hypertensive population.

The Newly Identified Hypertensive Patient: Cost‐Effective Laboratory Investigation

The Newly Identified Hypertensive Patient: Cost‐Effective Laboratory Investigation

Vascular Protection of Dual Therapy (Atorvastatin-Amlodipine) in Hypertensive Patients

Hypertension frequently coexists with other cardiovascular risk factors, such as hypercholesterolemia, and their combination is associated with a greater rate of cardiovascular events. Recent clinical data support that treatment of hypertensive patients with a combination of antihypertensive and lipid-lowering therapies leads to a higher reduction in the incidence of cardiovascular events. In the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA), an optimal prevention of cardiovascular events was reached in patients who were randomly assigned to atorvastatin and the amlodipine treatment. However, the potential underlying mechanisms of these vascular protective effects are not fully elucidated. Because experimental studies have shown that statins and calcium channel blockers have antiatherosclerotic effects, the effect of atorvastatin alone or in combination with amlodipine was analyzed in the protein secretion profile of atherosclerotic plaques that were cultured ex vivo. In this respect, the addition of atorvastatin and amlodipine to atherosclerotic plaques normalized the levels of the different released proteins to that obtained from healthy arteries. This review highlights recent clinical and experimental studies that support that a combined treatment of hypertensive patients with both statins and calcium channel blockers could promote a higher reduction in their global cardiovascular risk profile and associated mortality. As an example, the application of a proteomic approach to assess the modulation by atorvastatin alone or in combination with amlodipine on the proteins that are released by atherosclerotic plaques has allowed the identification of novel therapeutic targets by which these drugs could promote their additive/synergic effects.

Treatment of High-Risk Hypertensive Patients

Cardiovascular disease represents the leading cause of morbidity and mortality in Western countries, and hypertension-related cardiovascular events affect about 37 million people per year, worldwide. In this perspective, hypertension represents a reference paradigm to illustrate strategies aimed at achieving cardiovascular prevention. Hypertensive patients are at increased risk of experiencing a cardiovascular event during their life-time, and treatment of high blood pressure represents one of the most effective strategies to reduce the global cardiovascular risk of these patients. However, owing to its multifactorial pathophysiology and its frequent association with other relevant risk factors and clinical conditions, such as dyslipidaemia, diabetes mellitus, left ventricular dysfunction and renal impairment, hypertension requires an integrated approach to treatment, including life-style measures, antihypertensive drugs and other therapies (mostly lipid-lowering regimens). Yet worldwide, general practitioners continue to focus their attention on the management of a single risk factor, e.g. blood pressure, rather than on the global cardiovascular risk profile. Modern strategies of cardiovascular prevention should assess the global cardiovascular risk threshold to manage hypertensive patients at high risk, rather than to focus on the high level of a single risk factor, for achieving effective control of cardiovascular risk profile and reducing cardiovascular morbidity and mortality in the general population, as well as in the hypertensive population.

Global Cardiovascular Risk

Atherosclerosis is a multifactorial disease. This is supported by a large body of clinical and experimental data collected during the last 30 years, either in observational or in interventional clinical trials. During these years, a large number of risk factors and clinical conditions, closely related to the development of atherosclerosis, have been identified. The most relevant risk factors for cardiovascular disease are hyperlipidaemia, arterial hypertension, diabetes mellitus, cigarette smoking and family history.Cardiovascular risk factors interact with each other in a complex, and not fully elucidated fashion, contributing to the definition of a 'global cardiovascular risk profile'. Thus, the cardiovascular risk profile must be evaluated (through algorithms or risk charts) for each individual. Patients presenting with multiple cardiovascular risk factors have a higher risk of developing a major cardiovascular event, and in these patients a strict control of risk factors leads to an effective prevention of cardiovascular disease.In this latter regard, hypercholesterolemia deserves a 'dynamic' role. The most recent guidelines for the management of patients with hyperlipidaemia underscore the need for a more strict metabolic control in patients with prior cardiovascular events (secondary prevention), and also in patients with no evidence of cardiovascular disease (primary prevention), in which the concomitant presence of multiple risk factors or diabetes confers a high risk (e.g. patients with previous myocardial infarction or stroke).

How to Manage Metabolic Syndrome

Metabolic syndrome (MS) is a complex clinical condition, initially described as ‘metabolic syndrome X’, characterised by the presence in the same individual of multiple metabolic and cardiovascular traits, typically high blood pressure, abdominal obesity, lipid profile abnormalities, insulin resistance and glucose intolerance. More recently, other features have been proposed; in particular, chronic pro-inflammatory and pro-thrombotic states seem to further characterise MS. Because of its multifactorial pathogenesis, a unitary clinical management of MS is still debated and physicians tend to make individual choices. In particular, the threshold for treatment initiation is rather heterogeneous. However, a large body of observational studies have demonstrated that patients with MS have an increased incidence of major cardiovascular events, such as acute myocardial infarction and ischemic stroke, particularly in those patients with a high-risk profile (hypertensive patients with target organ damage or diabetes mellitus). An aggressive therapeutic approach for reducing global cardiovascular risk is effective in these subgroups. On the other hand, the lack of specific international guidelines, consisting of a diagnostic and therapeutic algorithm with accurate cardiovascular risk stratification, makes the clinical management of patients with MS by primary physicians difficult and not uniform. In particular, while there is convincing evidence that the progressive addition of components of MS increases cardiovascular risk, there are no consistent indications regarding treatment priorities and strategies. In this article we propose a global risk-based stratification, aimed at identifying ‘low-risk’ and ‘high-risk’ patients within those presenting the MS. This approach may prove to be of particular efficacy in clinical practice to identify patients with MS with different degrees of cardiovascular disease risk profile. This approach may also be helpful to develop therapeutic strategies based on global cardiovascular risk profile.

Circulating Vascular Cell Adhesion Molecules VCAM-1, ICAM-1, and E-Selectin in Dependence on Aging

Background: Elevated levels of circulating cell adhesion molecules (cCAMs) such as vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and endothelial leukocyte adhesion molecule-1 (E-selectin) are found in subjects with vascular diseases and in subjects with several risk factors for atherosclerosis. However, data evaluating cCAMs and biological age are limited. Objective: The purpose of this study was to assess in subjects with different cardiovascular risk profiles the levels of cVCAM-1, cICAM-1, and cE-selectin in dependence on age. Methods: The following groups of subjects were included in the study: 282 apparently healthy subjects of the average population aged 18–89 years, 77 vegetarians who are characterized by a favourable global cardiovascular risk profile, 94 patients with coronary heart disease, and 181 patients with peripheral arterial occlusive disease. Blood samples were obtained after an overnight fast for measurement of cCAMs, lipoproteins, and other clinical/biochemical parameters. The cCAM levels were determined by the use of monoclonal antibody based enzyme-linked immunosorbent assays. Results: Amongst the cCAMs, cVCAM-1 is uniquely elevated in elderly persons with different risks for atherosclerosis, including subjects of the average population, vegetarians with a favourable risk profile, and patients with both coronary heart disease and peripheral arterial occlusive disease. With respect to cICAM-1, an age-dependent elevation was found in the control subjects included in the study. The cE-selectin levels were not correlated with age. Moreover, no associations of cCAMs with serum lipid and lipoprotein levels were found. Conclusion: The results of the present study indicate that cVCAM-1 is an age-dependent parameter independent of cardiovascular risk.

Prevalence of Left Ventricular Hypertrophy and Carotid Thickening in a Large Selected Hypertensive Population: Impact of Different Echocardiographic and Ultrasonographic Diagnostic Criteria

Background: Left ventricular hypertrophy (LVH) and increased carotid intima-media thickness (IMT) represent independent risk factors for cardiovascular disease. Objective: To evaluate the prevalence of echocardiographic LVH and common carotid artery (CCA) intima-media (IM) thickening by different criteria in a large sample of hypertensive patients referred to our Hypertension Clinic. Methods: Echocardiograms and ultrasonographic carotid examinations have been performed in 640 consecutive hypertensives referred to our outpatient's hypertension unit. LVH was diagnosed using six different criteria, when left ventricular mass index (LVMI) exceeded (a)100 g/m 2 in women and 120 g/m 2 in men, (b) 110 g/m 2 in women and 125 g/m 2 in men, (c) 110 g/m 2 in women and 134 g/m 2 in men, (d) 125 g/m 2 in both sexes, (e) 47 g/h 2.7 in women and 51 g/h 2.7 in men, (f) 105 g/h in women and 126 g/h in men. Thickening of CCA IM was identified using three partition values; when IMT was (a) S 0.8 mm; (b) S 0.9 mm; (c) S 1.0 mm in both sexes. Results: Echocardiographic and ultrasonographic examinations of sufficient quality to be analysed were obtained in 611 patients (95.2%). Prevalence of LVH ranged from 18.6% (d) to 42.2% (f) and was significantly higher in men than in women by criteria (d) and (e), but slightly higher in women when using criteria (a) and (c). Eccentric hypertrophy was the most frequent type of LVH independently of the criteria used. Prevalence of IM thickening ranged from 14.7% (c) to 44.2% (a). Significant correlations between left ventricular mass (LVM)/body surface area, LVM/height and LVM/height 2.7 , and carotid IM thickness were found ( r = 0.41; p < 0.0001; r = 0.31; p < 0.0001; r = 0.30; p < 0.0001, respectively). Conclusion: The prevalence of LVH and CCA IM thickening in hypertensive patients is markedly dependent on the partition values used to define these markers of target organ damage. Considering the pivotal role of LVH and CCA IM thickening in assessing the global cardiovascular risk profile in hypertensives, improved standardization in defining LVH and carotid IM thickening is needed.