The assessment of total cardiovascular risk in hypertensive subjects in primary care

Figures & data

Figure 1. Design of the study. (SCORE = Systematic COronary Risk Evaluation; BMI = body mass index; ABI = ankle-brachial index.)

Table I. Base-line characteristics of the study population.

	Femalen = 272	Malen = 223	Alln = 495
Demographic
Age, years, mean (SD)	60 (7)	59 (7)	60 (7)
Weight, kg, mean (SD)	78.5 (15.7)	90.4 (14.3)	83.9 (16.2)
Body mass index, kg/m^2, mean (SD)	29.9 (5.7)	29.2 (4.2)	29.6 (5.1)
Waist circumference, cm	94.1 (13.0)	102.5 (10.7)	97.9 (12.7)
Current smokers, n (%)	30 (11)	37 (17)	67 (14)
Clinical, mean (SD)
Duration of HA, years, median (IQR)	5 (0–11)	4 (0–11)	4 (0–11)
LVH, n (%)	51 (19)	30 (13)	81 (16)
Blood pressure, mmHg, mean (SD)
Systolic	153.2 (17.3)	154.0 (15.9)	153.6 (16.7)
Diastolic	89.8 (8.0)	92.2 (8.0)	90.9 (8.1)
Pulse pressure	63.5 (14.6)	61.8 (13.4)	62.7 (14.1)
ABI, mean (SD)	1.06 (0.12)	1.07 (0.12)	1.07 (0.12)
eGFR, mL/min/1,73 m^2, mean (SD)	77.4 (15.3)	83.5 (16.6)	80.2 (16.2)
Framingham CVD score, %, mean (SD)	14 (9)	24 (13)	19 (12)
SCORE, %, mean (SD)	5 (7)	10 (7)	7 (7)
Biochemical, mean (SD)
hs-CRP, mg/L	2.75 (2.26)	2.24 (1.92)	2.52 (2.13)
Total cholesterol, mmol/L	5.31 (0.92)	5.14 (0.85)	5.23 (0.90)
LDL-cholesterol, mmol/L	3.14 (0.86)	3.06 (0.75)	3.11 (0.81)
HDL-cholesterol, mmol/L	1.57 (0.38)	1.41 (0.42)	1.50 (0.41)
Triglycerides, mmol/L	1.35 (0.58)	1.47 (0.73)	1.40 (0.65)
Fasting glucose, mmol/L	5.59 (0.85)	5.90 (1.15)	5.73 (1.01)
2-h glucose, mmol/L	8.00 (2.44)	7.80 (2.55)	7.91 (2.49)
Current medication, n (%)
Vasodilatators	135 (50)	127 (57)	262 (53)
Beta-blockers	87 (32)	65 (29)	152 (31)
Diuretics	48 (18)	38 (17)	86 (17)
Statins	47 (17)	34 (15)	81 (16)

HA = hypertension; IQR = interquartile range; LVH = left ventricular hypertrophy; ABI = ankle-brachial index; eGFR = estimated glomerular filtration rate; CVD = cardiovascular disease; SCORE = Systematic Coronary Risk Evaluation; hs-CRP = high-sensitivity C-reactive protein; LDL = low-density lipoprotein; HDL = high-density lipoprotein; Vasodilatators = angiotensin-converting enzyme inhibitor, angiotensin receptor antagonist, or calcium antagonist.

Table II. The diagnostic characteristics of the test (Framingham CVD risk, SCORE risk and hs-CRP) with a cut-off value of high risk in predicting target organ damage. Parentheses show 95% confidence intervals.

	Cut-off point	Accuracy	Sensitivity	Specificity	LR+
ABI <1.0
Framingham	≥20%	57 (52–61)	0.31 (0.23–0.40)	0.65 (0.60–0.70)	0.90 (0.66–1.20)
SCORE	≥5%	51 (47–56)	0.50 (0.41–0.60)	0.51 (0.46–0.57)	1.04 (0.84–1.26)
hs-CRP	>3	60 (56–65)	0.32 (0.24–0.41)	0.70 (0.65–0.75)	1.05 (0.77–1.41)
eGFR <60
Framingham	≥20%	64 (60–68)	0.37 (0.22–0.53)	0.67 (0.62–0.71)	1.09 (0.69–1.59)
SCORE	≥5%	52 (47–56)	0.54 (0.37–0.69)	0.51 (0.47–0.56)	1.10 (0.79–0.43)
hs-CRP	>3	67 (63–71)	0.34 (0.20–0.51)	0.70 (0.65–0.74)	1.13 (0.70–1.70)
LVH
Framingham	≥20%	62 (58–66)	0.37 (0.27–0.49)	0.67 (0.62–0.72)	1.14 (0.82–1.53)
SCORE	≥5%	53 (49–58)	0.57 (0.45–0.68)	0.52 (0.47–0.57)	1.19 (0.95–1.46)
hs-CRP	>3	64 (59–68)	0.32 (0.22–0.43)	0.70 (0.65–0.74)	1.06 (0.74–1.48)

LR+ = positive likelihood ratio; ABI = ankle-brachial index; SCORE = Systematic Coronary Risk Evaluation; hs-CRP = high-sensitivity C-reactive protein; eGFR = estimated glomerular filtration rate; LVH = left ventricular hypertrophy; CVD = cardiovascular disease.

Table III. The diagnostic characteristics of the test (Framingham CVD risk, SCORE risk and hs-CRP) with an optimal cutoff value by receiver-operating characteristic (ROC) curves in predicting target organ damage. Parentheses show 95% confidence intervals.

	AUC (95% CI)	Cut-off point	Accuracy	Sensitivity	Specificity	LR+
ABI <1.0
Framingham, %	0.49 (0.43–0.55)	17	55 (50–59)	0.44 (0.35–0.54)	0.58 (0.53–1.63)	1.06 (0.83–1.32)
SCORE, %	0.51 (0.45–0.57)	19	74 (70–78)	0.11 (0.06–0.18)	0.94 (0.92–0.96)	2.02 (1.06–3.78)
hs-CRP	0.52 (0.46–0.59)	6.4	75 (70–78)	0.14 (0.08–0.21)	0.95 (0.92–0.97)	2.57 (1.40–4.68)
P-value	0.30
eGFR <60
Framingham, %	0.54 (0.45–0.61)	14	48 (43–52)	0.66 (0.49–0.80)	0.46 (0.41–0.51)	1.22 (0.93–1.49)
SCORE, %	0.54 (0.46–0.63)	3	37 (33–41)	0.80 (0.65–0.91)	0.33 (0.29–0.37)	1.20 (0.97–1.37)
hs-CRP	0.59 (0.51–0.68)	1.5	45 (41–50)	0.78 (0.62–0.89)	0.42 (0.38–0.47)	1.35 (1.08–1.57)
P-value	0.68
LVH
Framingham, %	0.56 (0.50–0.62)	10	35 (30–39)	0.90 (0.81–0.96)	0.24 (0.20–0.28)	1.18 (1.06–1.28)
SCORE, %	0.58 (0.51–0.64)	5	53 (49–58)	0.57 (0.45–0.68)	0.52 (0.47–0.57)	1.19 (0.95–1.46)
hs-CRP	0.53 (0.47–0.59)	1.5	47 (42–51)	0.70 (0.59–0.80)	0.42 (0.37–0.47)	1.22 (1.02–1.42)
P-value	0.41

AUC = area under the curve; LR+= positive likelihood ratio; ABI = ankle-brachial index; SCORE = Systematic Coronary Risk Evaluation; hs-CRP = high-sensitivity C-reactive protein; eGFR = estimated glomerular filtration rate; LVH = left ventricular hypertrophy; CVD = cardiovascular disease.

Figure 2. Number of the study subjects classified as high-risk (test positive) or non-high-risk (test negative) subjects according to the risk estimation tests, and the number of patients with target organ damage within each test category. Cut-off points were 5% in SCORE, 20% in Framingham CVD score, and >3 mg/L in hs-CRP. (SCORE = Systematic COronary Risk Evaluation system; CVD = cardiovascular disease; hs-CRP = high-sensitivity C-reactive protein; ABI = ankle-brachial index; eGFR = estimated glomerular filtration rate; LVH = left ventricular hypertrophy).