[Do WHO-ISH guidelines identify high risk mild hypertensive patients?].

OBJECTIVE

To assess the ability of 1993 WHO-ISH recommendations to identify patients who need drug treatment.

METHODS

268 hypertensive patients with suspected mild hypertension were preselected for this study at their first visit at the referral center. 123 were included after a short in-hospital work-up when they fulfilled the 1993 WHO-ISH criteria for mild hypertension (90-105 mmHg diastolic BP and/or 140-180 mmHg systolic BP). Echocardiography was performed in all patients by the same investigator according to ASE convention. The combined 10-year risk of stroke and coronary heart disease was calculated with the Framingham equation. Patients were then followed up for six months by the same physician blinded to echographic results and risk calculations and applying the WHO-ISH guidelines (monthly BP measurement and subjective assessment of risk). Five patients were excluded, for reasons unrelated to the protocol.

RESULTS

The decision of drug treatment was taken at the 1st, 2nd, 3rd, 4th, 5th, 6th monthly visit after work-up in 2, 6, 25, 7, 2 and 6 patients, respectively. Among these 118 patients, 48 patients (29 male, 19 female) were eventually treated and 70 (49 male, 30 female) remained untreated. BP s at preselection and on a day of work-up were similar in both groups. Patients in whom drug treatment was prescribed were older and had higher lef ventricular mass (LVM) than untreated patients, but only 2 of them (all in the treated group) had LVM values above usual thresholds (LVM > 125 g/m2, in men and women). Stroke and coronary risks were both higher in treated than in untreated patients (p < 0.05). The physician using the guidelines decided to treat only 19 of the 38 patients with a 10-year risk < 10% (true positive), whereas she decided to treat with drugs 12 patients among the 44 with a 10-year risk < 5%.

CONCLUSION

The difference in LVM between untreated and treated patients support the validity of the WHO-ISH guidelines, but the measurement of LVM did not bring much information for managing the individual patient. Application of these guidelines did not satisfactorily identify high risk patients and could lead to over-treatment of low risk patients.