Cardiovascular risk stratification in unselected primary care patients with newly detected arterial hypertension

Cardiovascular risk (CVR) stratification in patients with arterial hypertension is essential. Few data are available on CVR factors (CVRFs), hypertensive target organ damage (TOD) and overall CVR in medical outpatients with newly detected arterial hypertension. General medical patients entering the Medical Outpatient Department of the University Hospital Basel, Switzerland, were screened for elevated office blood pressure (OBP of <140/90 mm Hg). Patients with newly detected arterial hypertension (elevated OBP at two consultations) underwent a work-up that included fundoscopy, urinalysis, ambulatory blood pressure (ABP) monitoring, ECG and echocardiography. CVR was calculated according to the 1999/2003 World Health Organization/International Society of Hypertension (WHO/ISH) guidelines. A total of 2615 outpatients were screened. Of 580 patients with elevated first OPB, 207 were treated for hypertension, 98 refused to participate, 8 were early dropouts and 36 had a normal second OBP. Data from 212 patients were analyzed (mean age 53+/-14 years). The first and second OBP readings were 162+/-6/100+/-6 and 153+/-14/96+/-9 mm Hg, respectively. Mean ABP was 134+/-12/83+/-9 mm Hg, and sustained hypertension was found in 76.9% of patients. Among patients with hypertension according to OPB monitoring, 61.3% had 1 or 2 CVRFs, and 33.0% had <or=3 CVRFs. Evidence of TOD, diabetes or associated clinical conditions (ACCs), such as renal or cardiovascular disease, was found in 26.4, 5.6 and 7.1% of patients, respectively. In terms of CVR, 2.4% of patients were at low risk, 25.9% at medium risk and 71.7% at high risk. No differences existed between white coat and sustained hypertensives regarding CVRFs, TOD or ACCs. Comprehensive analysis in patients with newly detected arterial hypertension revealed a surprisingly high prevalence of CVRFs, TOD and ACCs, indicating high CVR in the majority of these patients.