Department of Medical and Surgical Sciences, Clinica Medica, University of Brescia, Brescia, Italy.
J Hypertens. 2010 Sep;28(9):1935-43. doi: 10.1097/HJH.0b013e32833b4a55.
Hypertension guidelines underline the importance of quantification of total cardiovascular risk; an extensive evaluation of target organ damage (TOD) may increase the number of patients classified at high-added cardiovascular risk.
To assess the effect of the evaluation of different forms of TOD, in addition to 'routine' workup, on cardiovascular risk stratification in a general population sample in Northern Italy.
In 385 patients (age 57 +/- 10 years, 44% men, 64% hypertensives, 32% treated), left ventricular and carotid artery structure and carotid-femoral pulse wave velocity (PWV) were measured. All patients underwent laboratory examinations. Patients were divided into risk categories according to European Society of Hypertension/European Society of Cardiology guidelines before and after TOD evaluation.
After routine workup, patients were classified as follows: 6% at average cardiovascular risk, 35% at low cardiovascular risk, 25% at moderate cardiovascular risk, 33% at high cardiovascular risk and 1% at very high cardiovascular risk. The proportion of patients at low or moderate cardiovascular risk reclassified at high cardiovascular risk were 5, 14, 30 and 14% after echocardiography, measurement of albuminuria and estimated glomerular filtration rate, carotid ultrasound and PWV, respectively (chi P < 0.001 for all vs. routine). Assessment of PWV in addition to echocardiography led to an increase of the proportion of patients at high risk (from 5 to 15%, P < 0.001), as for PWV in addition to albuminuria, estimated glomerular filtration rate or both (from 14 to 31%, P < 0.01), but did not affect risk stratification in addition to carotid ultrasound (from 30 to 34%, P = NS).
Our data suggest that measurement of PWV may significantly change cardiovascular risk stratification in addition to echocardiography and to detection of albuminuria and/or of a reduction of estimated glomerular filtration rate, but not after carotid ultrasound. Our results confirm that evaluation of different forms of TOD is useful for a more accurate assessment of global cardiovascular risk.
高血压指南强调了量化心血管总体风险的重要性；对靶器官损害（TOD）进行广泛评估可能会增加被归类为高附加心血管风险的患者数量。
评估在意大利北部的一般人群样本中，除了“常规”检查外，评估不同形式的 TOD 对心血管风险分层的影响。
在 385 名患者（年龄 57 +/- 10 岁，44%男性，64%高血压患者，32%接受治疗）中，测量了左心室和颈动脉的结构以及颈动脉-股动脉脉搏波速度（PWV）。所有患者均进行了实验室检查。根据欧洲高血压学会/欧洲心脏病学会指南，在 TOD 评估前后将患者分为风险类别。
在常规检查后，患者被分类为：平均心血管风险 6%，低心血管风险 35%，中心血管风险 25%，高心血管风险 33%，极高心血管风险 1%。经过超声心动图、白蛋白尿和估计肾小球滤过率、颈动脉超声和 PWV 测量后，低或中心血管风险的患者重新归类为高心血管风险的比例分别为 5%、14%、30%和 14%（所有与常规相比，chi P < 0.001）。除了超声心动图之外，评估 PWV 可导致高风险患者的比例增加（从 5%到 15%，P < 0.001），而对于 PWV 加上白蛋白尿、估计肾小球滤过率或两者（从 14%到 31%，P < 0.01），但不会影响除颈动脉超声外的风险分层（从 30%到 34%，P = NS）。
我们的数据表明，除了超声心动图以及检测白蛋白尿和/或估计肾小球滤过率降低之外，测量 PWV 可能会显著改变心血管风险分层，但在颈动脉超声之后则不会。我们的结果证实，评估不同形式的 TOD 对于更准确评估全球心血管风险是有用的。
