3.3 Role of a Specialist Hospital Centre In Hypertensive Patients Risk Stratification
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Epidemiology 3.3 Role of a Specialist Hospital Centre In Hypertensive Patients Risk Stratification M. Crippa (1), S. Ettori (2), R. Costa (1), F. Zani (1), F. Del Magro (3), S. Camanini (3), G. Zanolini (2), R. Fariello (2) (1)Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy, (2)Azienda ` degli Studi di Ospedaliera Mellino, Mellini Chiari, Chiari, Italy, (3)Universita Brescia, Brescia, Italy Introduction. In clinical practice it is common to find hypertensive patients who are ‘overtreated’ or ‘undertreated’ based on the mere Blood Pressure value. In the good clinical practice the importance of the application of the ESH ESC 2007 guidelines has been evaluated to identify accurately the hypertensive patient’s CV risk and decide ‘timing’ and type of hypertensive therapy. We examined 130 patients from Gardone Val Trompia (BS) district coming in succession to our outpatients’ department suffering from essential hypertension not in treatment, or under anti-hypertensive therapy, but with >140/90mmHg office BP. Methods. Patients underwent medical examination, blood and urine samples (glycaemia, lipid profile, MAL, renal function, and creatinine clearance with Cockcroft and Gault) and instrumental investigations (electrocardiogram, echocardiogram, Fundus Oculi, ambulatory blood pressure monitoring). Results. The CV risk obtained only from the outpatients’ department visit (BP values, clinical history, waist circumference) was reported as follows: Average, Low and Moderate added risk 102 patients; High 11; Very High 17. At the end of the laboratory and instrumental investigations patients were restratified as: Average, Low and Moderate added risk 46 patients; High 62; Very High 22 (see figure). The prevalence of risk factors and target organ damage was distributed as follows: metabolic syndrome 39%; LDL >115 mg/dl 75%; IFG 42%; diabetes 12%; LVH Eco 8%; LVH ECG 2%; Microalbuminuria 15%; creatinine clearance < 60 ml/min 8%.
Conclusions. By the execution of recommended guidelines examinations, we could re-stratify patients’ CV risk identifying a considerable number of hypertensive patients with ‘high added risk’ or ‘very high added risk’ who consequently require an immediate active treatment, with the appropriate drug classes and with more rigorous BP targets to obtain depending on the associated risk factors or signs of organ damage.
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