A18644 Echocardiography in Low-Risk Hypertensive Patients. When is it needed?

Objectives: It is not clear whether echocardiography (echo) should be part of the diagnostic work-up in all hypertensive patients. Methods: In the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale, we identified pre-test predictors of echo left ventricular hypertrophy (LVH), and their prognostic impact, in 2,150 initially untreated hypertensive patients without LVH at electrocardiogram (ECG). All patients underwent ECG, echo and 24-hour ambulatory blood pressure (BP) monitoring. Results: Mean age was 48.7 years. At entry, mean office BP was 154/97 mmHg and mean 24-hour ambulatory BP was 135/86 mmHg. Prevalence of LVH at echo (LV mass > 47.0 g/height [m2.7] in women and > 50.0 g/height [m2.7] in men) was 37.1%. A nomogram based on 6 items (age, smoking, body mass index, office systolic and diastolic BP, Cornell voltage and chronic kidney disease) allowed to estimate a pre-test probability of LVH ranging from < 10% (score ≤ 100 points) to >90% (score ≥180 points). Prevalence of LVH progressively increased with the total score (p < 0.001). During a mean follow-up period of 9.53 years there were 236 major cardiovascular (CV) events (1.15 per 100 patient-years). In the 10% of population grouped in the lower decile of the score there was only one patient with a CV event and no patients with LVH among men, and one patient with a CV event and one with LVH among women. In a Cox model, the hazard ratio for cardiovascular events was 0.67 (95% CI: 0.59–0.75; p < 0.001) and 5.11 (95% CI: 3.18–8.21; p < 0.001) for a total score below or above 100 points, respectively. Conclusion: this multifactorial score allows identification of a consistent group of hypertensive patients with low pre-test probability of LVH and low CV risk. In these patients, echo may not be needed in the individual diagnostic work-up.