Cardiovascular risk assessment in hypertensive patients:: major discrepancy according to ESH and SCORE strategies

Background The European Society of Hypertension (ESH) guidelines recommend two possible strategies for the assessment of cardiovascular risk (CVR) in essential hypertensive ( HT) patients: categorical tables and SCORE risk charts. However, the outcome of these methods has not been compared. Objective and methods We assessed CVR according to ESH and SCORE risk charts adapted to use in Belgium in 106 HT patients ( mean age: 52.4 +/- 12.9 years, male/female ratio: 46/60) without diabetes or other associated clinical conditions. Results The distribution of low, moderate, high and very high added risk was strikingly different ( kappa coefficient=0.08) according to ESH categorical tables ( n=1, 24, 24, 57) and SCORE risk charts ( n=60, 12, 10, 24). Furthermore, compared with ESH, CVR class according to SCORE was lower in the majority of patients ( n=72, 68%) while it was similar in 23 (22%) and higher in 11 patients ( 10%). Patients for whom risk was lower by SCORE compared to ESH differed from the others by age ( 46.7 +/- 10.0 versus 64.6 +/- 9.2, P < 10(-3)) and proportion of females ( 71 versus 26%, P < 10(-4)). Conclusions In this series of patients with mainly moderate or severe hypertension, the distribution of cardiovascular risk was strikingly different according to ESH categorical tables and SCORE risk charts. This might be explained in part by the lower weight attributed to blood pressure in risk assessment, especially in young female subjects. If confirmed, these results should prompt the performance of a prospective study to assess which strategy most accurately predicts CVR in hypertensive patients. J Hypertens 25: 757 - 762 (c) 2007 Lippincott Williams & Wilkins.