Carotid atherosclerosis and cardiovascular risk stratification : role and cost-effectiveness of echo-doppler examination in untreated essential hypertensives

Objective. To investigate the impact and cost-effectiveness of carotid ultrasonographic examination on total risk stratification in low-medium risk hypertensive patients in relation to age (<50 and ≥50 years) and gender. Methods. Five hundred and eighty untreated hypertensives classified at low-medium risk, after the routine work-up recommended by the 2003 ESH/ESC guidelines, were included in the study and total risk was reassessed by adding the results of carotid ultrasonography. Results. According tothe stratification based on routine work-up 16.3% of the whole population was considered at low added risk and 83.7% at medium added risk. Carotid subclinical damage was found in 158 patients (27.0%), who were then reclassified in the high-risk stratum. Prevalence rates of patients reclassified in the high-risk stratum as a consequence of carotid damage were as follows: 12.6% in men <50 years, 14.1% in women <50 years, 53.0% in men ≥50 years and 40.1% in women ≥50 years. The cost per detected case of carotid atherosclerosis was €473 in patients <50 years and €133 in those ≥50 years. Conclusions. Our results show that: (i) the use of carotid ultrasonography allows a much more accurate identification of high-risk individuals; (ii) its impact and cost-effectiveness on the risk stratification process differs markedly according to the age and gender; (iii) the selective use of this procedure in subjects at high risk of target organ damage may substantially improve the cost of primary prevention.