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Factors influencing cardiovascular risk in patients with hypertension Demographic characteristics and laboratory parameters

Factors influencing cardiovascular risk in patients with hypertension Demographic characteristics and laboratory parameters

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... Detailed information on CV risk assessment is available. 35 Factors influencing CV risk factors in patients with hypertension are shown in Table 4. Hypertensive patients with documented CVD, including asymptomatic atheromatous disease on imaging, type 1 or type 2 diabetes, very high levels of individual risk factors (including grade 3 hypertension), or chronic kidney disease (CKD; stages 3 -5), are automatically considered to be at very high (i.e. ...
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... all other hypertensive patients, estimation of 10 year CV risk using the SCORE system is recommended. Estimation should be complemented by assessment of hypertension-mediated organ damage (HMOD), which can also increase CV risk to a higher level, even when asymptomatic (see Table 4 and sections 3.6 and 4). ...
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... 3.6 Importance of hypertensionmediated organ damage in refining cardiovascular risk assessment in hypertensive patients A unique and important aspect of CV risk estimation in hypertensive patients is the need to consider the impact of HMOD. This was previously termed 'target organ damage', but HMOD more accurately Table 6 Risk modifiers increasing cardiovascular risk estimated by the Systemic COronary Risk Evaluation (SCORE) system describes hypertension-induced structural and/or functional changes in major organs (i.e. the heart, brain, retina, kidney, and vasculature) ( Table 4). There are three important considerations: (i) not all features of HMOD are included in the SCORE system (CKD and established vascular disease are included) and several hypertensive HMODs (e.g. ...
Context 4
... of the requirements for a comprehensive clinical examination are outlined in Table 13, and this should be adapted according to the severity of hypertension and clinical circumstances. Suggested routine clinical investigations are outlined in Table 14. ...

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... The register included data about demographic factors (age, sex and smoking habits), comorbidities such as hypertension (grade based on ESC 2018 Classification [15]), duration, target organ damage-chronic kidney disease, left ventricular hypertrophy, and cardiovascular and cerebrovascular events; family history of hypertension and premature cardiovascular disease, hypokalemia, type 2 diabetes mellitus, obesity, dyslipidemia and sleep apnea syndrome. Information about medical treatment with antihypertensive (type, number, and doses), oral antidiabetic and lipid-lowering medications, potassium supplements and antiplatelet agents was also registered. ...
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The association between raised blood pressure and increased risk of subsequent cognitive decline is well known. Left ventricular hypertrophy (LVH), as a marker of hypertensive target organ damage, may help identify those at risk of cognitive decline. We assessed whether LVH was associated with subsequent cognitive decline or dementia in hypertensive participants aged ≥80 years in the randomized, placebo-controlled Hypertension in the Very Elderly Trial. LVH was assessed using 12-lead electrocardiography (ECG) based on the Cornell Product (CP-LVH), Sokolow-Lyon (SL-LVH), and Cornell Voltage (CV-LVH) criteria. The Mini-Mental State Examination (MMSE) was used to assess cognitive function at baseline and annually. A fall in MMSE to <24 or an annual fall of >3 points were defined as cognitive decline and triggered dementia screening (Diagnostic Statistical Manual IV). Death was defined as a competing event. Fine-Gray regression models were used to examine the relationship between baseline LVH and cognitive outcomes. There were 2645 in the analytical sample, including 201 (7.6%) with CP-LVH, 225 (8.5%) SL-LVH and 251 (9.5%) CV-LVH. CP-LVH was associated with increased risk of cognitive decline, subdistribution hazard ratio (sHR)1.3 (95% confidence interval (CI) 1.01–1.67) in multivariate analyses. SL-LVH and CV-LVH were not associated with cognitive decline (sHR1.06 (95% CI 0.82–1.37) and sHR1.13 (95% CI 0.89–1.43), respectively). LVH was not associated with dementia. LVH may be related to subsequent cognitive decline, but evidence was inconsistent depending on ECG criterion and there were no associations with incident dementia. Additional work is needed to understand the relationships between blood pressure, LVH assessment and cognition.
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