Should we perform an echocardiogram in hypertensive patients classified as having low and medium risk?

Background Left ventricular hypertrophy is an important predictor of cardiovascular risk and its detection contributes to risk stratification. However, echocardiography is not a routine procedure and electrocardiography (ECG) underestimates its prevalence. Objective To evaluate the prevalence of echocardiographic left ventricular hypertrophy in low and medium risk non-treated hypertensive subjects, in order to find out the percentage of them who would be reclassified as high risk patients. Methods Cross-sectional, multicenter study was performed in hospital located hypertension units. An echocardiogram was performed in 197 previously untreated hypertensive patients, > 18 years, classified as having low (61%) or medium (39%) risk, according to the OMS/ISH classification. The presence of left ventricular hypertrophy was considered if left ventricular mass index was ≥ 134 or 110 gr/m2 in men and women, respectively (Devereux criteria). A logistic regression analysis was performed to identify factors associated to left ventricular hypertrophy. Results The prevalence of left ventricular hypertrophy was 23.9% (95% CI : 17.9–29.9), 25.6% in men and 22.6% in women. In the low risk group its prevalence was 20.7% and in medium risk group 29.5%. Factors associated to left ventricular hypertrophy were: years since the diagnosis of hypertension, OR : 1.1 (95% CI : 1.003–1.227); systolic blood pressure, OR : 1.08 (95% CI : 1.029–1.138); diastolic blood pressure, OR : 0.9 (95% CI : 0.882–0.991); and family history of cardiovascular disease, OR : 4.3 (95% CI : 1.52–12.18). Conclusions These findings underline the importance of performing an echocardiogram in low and high risk untreated hypertensive patients in which treatment would otherwise be delayed for even one year.