Can echocardiography identify mildly hypertensive patients at high risk, left untreated based on current guidelines?

Objective To determine whether the decision to treat uncomplicated mild hypertension with drugs, in accordance with the World Health Organization - International Society of Hypertension (WHO/ISH) guidelines based on a series of blood pressure (BP) measurements over 6 months, resulted in the treatment of patients at high risk on the basis of echocardiography. Methods One hundred and eighteen patients with mild hypertension (diastolic blood pressure 90-105 mmHg and/or systolic blood pressure 140-180 mmMg) were examined by echocardiography at inclusion and followed up for 6 months by a single physician unaware of the echographic results. Results Drug treatment was given to 48 patients, and 70 remained untreated. Treated patients had higher echographic indices than untreated patients (all P < 0.05): left ventricular (LV) mass/body surface area (83.0 +/- 15.6 versus 75.3 +/- 14.8 g/m(2)), inter-ventricular septal thickness (9.7 +/- 1.7 versus 8.5 +/- 1.3 mm), LV posterior wall thickness (8.4 +/- 1.1 versus 7.8 +/- 1.1 mm), relative wall thickness (0.37 +/- 0.06 versus 0.34 +/- 0.06). LV geometry was normal in 98 patients, and 20 had LV concentric remodelling. The 10-year coronary disease risk (Framingham equation) was higher in the 20 patients with concentric remodelling than in those with normal LV geometry (10.4 versus 4.2%; P < 0.005). Nine of these 20 patients were still untreated at the end of the 6-month follow-hip period. Conclusion Rigorous application of the WHO/ISH clinical guidelines in a group of mild hypertensive patients led to the treatment of patients with slightly higher LV mass and more concentric LV geometry than were found in those not treated. However, a high-risk subgroup, with concentric remodelling, was not identified and left untreated. J Hypertens 1999, 17:817-824 (C) Lippincott Williams & Wilkins.