array:23 [ "pii" => "S1889183717300259" "issn" => "18891837" "doi" => "10.1016/j.hipert.2017.04.001" "estado" => "S300" "fechaPublicacion" => "2017-10-01" "aid" => "311" "copyright" => "SEH-LELHA" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Hipertens Riesgo Vasc. 2017;34:149-56" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 75 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 10 "PDF" => 63 ] ] "itemSiguiente" => array:18 [ "pii" => "S1889183717300272" "issn" => "18891837" "doi" => "10.1016/j.hipert.2017.04.003" "estado" => "S300" "fechaPublicacion" => "2017-10-01" "aid" => "313" "copyright" => "SEH-LELHA" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Hipertens Riesgo Vasc. 2017;34:157-64" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 50 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 15 "PDF" => 33 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Valores de presión arterial obtenidos en población adolescente de la Comunidad de Madrid: Tablas basadas en el estudio MEPAFAC" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "157" "paginaFinal" => "164" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Blood pressure values in adolescents in the Community of Madrid: Tables based on the MEPAFAC Study" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1111 "Ancho" => 1601 "Tamanyo" => 91310 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Comparación de los diferentes valores p50 de PAS de nuestra muestra con estudios internacionales.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Molinero, M. Cervero, M.C. Magro, T. Partearroyo, P. Zuluaga, A. Martín" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Molinero" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Cervero" ] 2 => array:2 [ "nombre" => "M.C." "apellidos" => "Magro" ] 3 => array:2 [ "nombre" => "T." "apellidos" => "Partearroyo" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Zuluaga" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Martín" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1889183717300272?idApp=UINPBA00004N" "url" => "/18891837/0000003400000004/v1_201710191212/S1889183717300272/v1_201710191212/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1889183717300788" "issn" => "18891837" "doi" => "10.1016/j.hipert.2017.09.001" "estado" => "S300" "fechaPublicacion" => "2017-10-01" "aid" => "329" "copyright" => "SEH-LELHA" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Hipertens Riesgo Vasc. 2017;34:145-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 54 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 26 "PDF" => 26 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Estrategia óptima de búsqueda de daño de órgano diana asintomático en el hipertenso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "145" "paginaFinal" => "148" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Most advisable strategy in search of asymptomatic target organ damage in hypertensive patients" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Blanch, R. Freixa-Pamias" "autores" => array:2 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Blanch" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Freixa-Pamias" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1889183717300788?idApp=UINPBA00004N" "url" => "/18891837/0000003400000004/v1_201710191212/S1889183717300788/v1_201710191212/es/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Most advisable strategy in search of asymptomatic target organ damage in hypertensive patients" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "149" "paginaFinal" => "156" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Abellán-Huerta, L. Prieto-Valiente, L. Consuegra-Sánchez, S. Montoro-García, A.B. Salguero-Merino, R. Morales-López, J. Abellán-Alemán, F. Soria-Arcos" "autores" => array:8 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Abellán-Huerta" "email" => array:1 [ 0 => "doctorabellan@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Prieto-Valiente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Consuegra-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "S." "apellidos" => "Montoro-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "A.B." "apellidos" => "Salguero-Merino" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "R." "apellidos" => "Morales-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "J." "apellidos" => "Abellán-Alemán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 7 => array:3 [ "nombre" => "F." "apellidos" => "Soria-Arcos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Cardiología, Hospital General Universitario Santa Lucía, Cartagena, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Cátedra de Riesgo Cardiovascular, Universidad Católica de Murcia, Murcia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Centro de Salud Virgen de la Caridad, Cartagena, Murcia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estrategia óptima de búsqueda de daño de órgano diana asintomático en el hipertenso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1260 "Ancho" => 1625 "Tamanyo" => 99254 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Relative proportion of patients with identified target organ damage at each step of the diagnostic algorithm. TOD: target organ damage.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The cardiovascular risk stratification in primary prevention commonly refers to the use of demographic clinical data (age, gender, family history of cardiovascular disease) and cardiovascular risk factors (diabetes, dyslipidaemia, hypertension, etc.).<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">1</span></a> Likewise, the clinical guidelines for arterial hypertension recommend searching for silent target organ damage (TOD) in both hypertensive and prehypertensive patients.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a> It has been shown that the presence of subclinical TOD is of major importance in the treatment and management of the hypertensive patient.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">3</span></a> In addition, silent TOD is a predictor for future cardiovascular events independent of the Systematic COronary Risk Evaluation (SCORE)<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">4,5</span></a> and involves an additional risk according to the ESH/ESC guidelines.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Notwithstanding, the asymptomatic character of most forms of vascular lesions makes the stratification process even more difficult. Moreover, the application frequency is relatively low in spite of the predictive value of TOD detection,<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5–9</span></a> mainly due to the lack of consensus regarding the most suitable and feasible approach or search strategy for TOD in the hypertensive patient.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The current study aims to evaluate the usefulness and performance of seven different methods systematically applied to TOD identification in a cohort of hypertensive patients without cardiovascular disease (CVD): glomerular filtration rate (GFR), albumin/creatinine ratio (ACR), electrocardiogram (ECG) to measure Cornell and Sokolow criteria, echocardiogram (ECO) to check for left ventricular hypertrophy (LVH), ankle–brachial index (ABI), pulse wave velocity (PWV), and carotid ultrasound in order to estimate the occurrence of plaques and intima media thickness (IMT). The main objective is to offer a research tool that could serve as a clinical guide when facing the difficult task of risk stratification in asymptomatic hypertension.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design study and population</span><p id="par0020" class="elsevierStylePara elsevierViewall">The current study is an observational, descriptive and cross-sectional study assessed in hypertensive patients who were attending their general practitioner. The recruitment was carried out by consecutive sampling in several health centres in our hospital area, with urban characteristics. Inclusion criteria were as follows: patients treated pharmacologically, with no changes in antihypertensive pharmacological treatment or hospital admissions for any cause within the previous three months. Patients with chronic renal failure stage ≥4 or overt CVD (cerebrovascular events, coronary artery disease, heart failure, symptomatic peripheral arterial disease or hospital admission due to CVD) were excluded from the study. All participants provided written informed consent. The study was performed in accordance with the Helsinki declaration and was approved by the Area Research Ethics Committee.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Anamnesis, physical examination and blood pressure measurement</span><p id="par0025" class="elsevierStylePara elsevierViewall">The demographic and clinical variables were recorded at inclusion (age, gender), year of hypertension diagnosis, antihypertensive treatment and doses, history of smoking, type-2 diabetes and alcohol consumption. Trained nurses recorded weight, height and abdominal perimeter. Body mass index (kg/m<span class="elsevierStyleSup">2</span>) was also calculated. Blood pressure was measured automatically using a validated Omron sphygmomanometer (HEM-7221-E8) by the general practitioner early in the morning according to the ESH/ESC recommendations.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a> Patients were defined as having controlled hypertension in accordance with ESC/ESH guidelines.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Systematic search strategy for TOD</span><p id="par0030" class="elsevierStylePara elsevierViewall">All the participants underwent a systematic search strategy for silent TOD, including the following exploratory examinations: First, general blood analysis for the measurement of creatinine levels (spectrophotometry) and calculation of the GFR through the Modification of Diet in Renal Disease (MDRD) equation<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">10</span></a> (in ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>). Second, urine analysis for the measurement of the ACR (inmunoturbidimetry) in a single morning sample.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a> A 30<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>GFR<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> calculated GFR or 30<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>ACR<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>300<span class="elsevierStyleHsp" style=""></span>mg/g denoted renal TOD. Third, a 12-lead electrocardiogram (ECG) for the systematic diagnosis of LVH. A Sokolow-Lyon voltage greater than 35<span class="elsevierStyleHsp" style=""></span>mm was considered LVH, as the current guidelines recommend.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a> A Cornell voltage greater than 28<span class="elsevierStyleHsp" style=""></span>mm in males and 20<span class="elsevierStyleHsp" style=""></span>mm in females were considered ECG-LVH criteria.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">12</span></a> Fourth, echocardiogram (ECO) with the use of Siemens Acuson SC2000 echocardiographers. An experienced cardiologist blindly evaluated left ventricular mass, using M-mode and following the American Society of Echocardiography recommendations<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">13</span></a> (2D measurement whenever the proper ventricular alignment was not successful). The criteria for the diagnosis of LVH were ventricular mass<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>115<span class="elsevierStyleHsp" style=""></span>g/m<span class="elsevierStyleSup">2</span> in males or >95<span class="elsevierStyleHsp" style=""></span>g/m<span class="elsevierStyleSup">2</span> in females.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a> Fifth, ankle–brachial index (ABI) was assessed by trained nurses, with the use of a continuous wave Doppler (Hadeco ES-100V3) and manual sphingomanometers calibrated with the appropriate cuff sizes. The methodology followed the current recommendations.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a> The criteria for pathological vascular TOD was considered when ABI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.9.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a> Sixth, pulse wave velocity (PWV) was measured using Siemens Acuson SC2000 ultrasound and pulse wave Doppler with synchronized ECG to determine pulse wave velocity from the right carotid to the right femoral artery.<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">15,16</span></a> An experienced operator obtained three separate measurements of each determination, performing average of all. There is evidence that this method has good correlation with arterial tonometry.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">17</span></a> A vascular TOD was considered when PWV was >10<span class="elsevierStyleHsp" style=""></span>m/s. Seventh, carotid Ultrasound imaging with the use of a Siemens Acuson SC2000 and a high frequency probe tone (9<span class="elsevierStyleHsp" style=""></span>MHz, 9L4). An experienced neurologist estimated the presence of plaque, its severity, as well as the common carotid artery intima media thickness (IMT) by the ARIC (Atherosclerosis Risk in Communities) study method.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a> An IMT<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.9<span class="elsevierStyleHsp" style=""></span>mm or plaque presence (focal thickening exceeding 50% of the surrounding IMT) was considered pathological.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Considerations for the algorithm for silent TOD detection</span><p id="par0035" class="elsevierStylePara elsevierViewall">In order to develop the most effective strategy search for TOD, the following aspects were taken into account:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">(1)</span><p id="par0040" class="elsevierStylePara elsevierViewall">The main objective was to come up with a diagnostic algorithm that could become useful in the daily routine of clinicians who, most often, do not have easy access to sophisticated tests. Instead, we considered the first examinations to be performed and included in the algorithm should be the most available and affordable, independently of the doctor's area of influence (Hospital or Primary Care). Thus, the ECG, the GFR by the MDRD, the ACR and the ABI were initially included as a whole in the algorithm.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">(2)</span><p id="par0045" class="elsevierStylePara elsevierViewall">From that point, a step-by-step approach is applied, identifying the most effective examination as the one demonstrating a higher proportion of TOD, once patients already diagnosed with TOD in earlier steps have been excluded.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">(3)</span><p id="par0050" class="elsevierStylePara elsevierViewall">We considered the IMT and the presence of carotid plaque the same examination and, therefore, they are indistinguishable when delivering the results of the test (namely carotid TOD).</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">The variables are presented as means and standard deviation and proportions with 95% confidence intervals (CI). The normal approximation to the binomial distribution was used with a sample size above 30 and sample proportion not inferior to 0.10 or superior to 0.90. Whenever those conditions were not accomplished, the exact calculation was established with the use of binomial or Poisson distribution if the simple size was superior to 100 and the proportion rate inferior to 0.05. Statistics were computed using STATA v12.1 (College Station, TX).</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Baseline characteristics of the population</span><p id="par0060" class="elsevierStylePara elsevierViewall">A total of 156 hypertensive patients were included in the present study. One patient was excluded due to a GFR <30<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> and two others did not accomplish all the exploratory tests of the strategy. Thus, the final cohort included 153 patients. The mean age of the cohort was 64.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.9 years old, 45.8% were males. Active smokers were 12% of the sample, and 60.1% and 15% presented dyslipidaemia and diabetes, respectively. All the population was under antihypertensive treatment. Baseline characteristics of the sample are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The rate of controlled hypertension was 59%. The type of antihypertensive drug and its proportion are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. The body mass index and abdominal perimeter in females was pathologically high and borderline in males.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Presence of silent TOD</span><p id="par0065" class="elsevierStylePara elsevierViewall">The results from the complementary exploratory tests are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. It is important to highlight the relatively normal mean values of the exploratory tests that did not show, on average, great organ damage, except for the relatively high (48%) prevalence of carotid TOD. Average GFR was 85.4<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>, mean voltage ECG criteria were 14.1 and 19<span class="elsevierStyleHsp" style=""></span>mm (Cornell and Sokolow criteria, respectively), average left ventricular mass 93.8<span class="elsevierStyleHsp" style=""></span>g/m<span class="elsevierStyleSup">2</span> and 81.1<span class="elsevierStyleHsp" style=""></span>g/m<span class="elsevierStyleSup">2</span> (for males and females respectively), normal average values of carotid IMT (0.8<span class="elsevierStyleHsp" style=""></span>mm), as well as normal mean values of ABI (1, absolute number) and PWV (9.5<span class="elsevierStyleHsp" style=""></span>m/s). Even when we performed all tests in all patients, for different reasons, GFR was not appropriately calculated in 3 individuals (2%); ACR in one patient (0.7%), ECG was not interpretable in 19 individuals (12.4%) (due to branch block or pacemaker), 7 patients presented with a poor acoustic window that precluded reliable measures of the left ventricle in the ECO (4.6%), the IMT was not determined in 5 individuals (3.3%) and the ABI could not be properly measured in 12 patients (7.8%), nor the PWV in 14 patients (9.1%).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The proportion of examinations with a pathological diagnosis is presented in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>. Carotid TOD was the most frequent form of TOD as 48% of the patients displayed an abnormal IMT (23.6%) or presented carotid plaques (37.2%). Vascular TOD was found in 37.9% of the individuals (a positive ABI 16.3% or pathological PWV 32.6%), cardiac TOD in 25% (9.7% ECG and 19.9% ECO) and renal TOD in 22.7% (14% an abnormal GFR and 15% a pathological ACR).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Likewise, from a total of 153 patients, 126 (82.4%) displayed one or more forms of TOD. Out of these, 62 individuals (40.5%) showed 1 TOD, 47 (30.7%) 2 TOD, 9 patients (5.9%) were positive for three TOD areas and 8 (5.2%) showed abnormal results in four types of TOD. None of the patients presented 5 or more pathological results in any of the complementary tests.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Proposed algorithm for silent TOD detection</span><p id="par0080" class="elsevierStylePara elsevierViewall">We thus applied the set of four basic diagnostic tests together—ECG, the GFR by the MDRD, the ACR and the ABI—(<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). That initial screening identified 57 patients (37%; CI: 29.6–44.9%) displaying abnormality criteria in at least one of the detection tests for TOD. From then on, the test for TOD in the carotid arteries was found to be the most effective in the remaining 96 patients since it identified vascular damage in 55% of the cohort (CI: 42.1–62.1%) (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>50). Only 46 patients presented normal values after the previous tests. On top of that, the PWV allowed us to diagnose TOD in 28% of them (CI: 15.2–41.2%) (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13). Finally, the ECO allowed detecting LVH in an additional 18% (CI: 5.0–31.3%) of the 33 remaining patients. Therefore, only 27 patients (17.6%) were really free of TOD. <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> represents graphically the different proportions of patients with TOD with our step-by-step proposed approach.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">If we do not take into account those 27 patients who finally did not have diagnosed TOD, the first set of four examinations identified 45% of the patients with actual TOD. However, when the results of the IMT/plaques were taken into consideration, the identification of TOD rose to 85% of the cohort affected with any form of TOD. At that step, only 19 patients (11%) who after a complete workup would end-up having TOD were TOD-negative (after carotid examination). In other words, the carotid ultrasound—after assessing the four examinations in primary care—was able to properly classify 89% of the TOD-positive population. In addition, the PWV contributed to the identification of a total of 95% of the individuals, and 96% of the included hypertensive patients were correctly classified (with/without TOD). The ECO added a minor contribution identifying the presence of ECO-LVH in the remainder of the affected population.</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">The purpose of the present study was to define a novel strategy that could be systematically applied when searching for silent TOD in asymptomatic hypertensive patients without CVD. Others investigations have evaluated the diagnostic yield of a myriad of diagnostic tools although, to our knowledge, none of them either used such a wide spectrum of tests as we did or used a step-by-step approach in which finding a positive test conditioned the performance of the next one. In order to provide an approach that is in accordance with general practice, we considered that the first diagnostic approaches should be an ECG, an ABI, a GFR and an ACR. Likewise, the current ESC/ESH Clinical Guidelines credit the greatest availability and cost-effectiveness to the ECG, the estimation of the GFR and the detection of microalbuminuria.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a> In our field of activity, the ABI measurement is greatly ingrained in our clinical practice so we also included that test to the initial screening. The proposed model was able to identify a silent TOD in 37% of the cohort.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The proportion of a cardiac TOD detected by an ECG in other hypertensive populations elsewhere was between 0.6% and 40%, depending on the selected cohort and the criteria used.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a> In a cohort of 855 hypertensive patients, Cuspidi et al. found similar proportions of LVH than the present study.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">20</span></a> The prevalence of a pathological ABI in our cohort was 16.3%, which is also in accordance with data published in the literature, ranging from 14.4% in the Farkas et al. study<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">21</span></a> to the 7.3% in the study by Korhonen et al.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">22</span></a>—which included a younger population than our study. The presence of microalbuminuria (15%) was also comparable to previously reported literature dealing with younger hypertensive patients such as the AusDiab<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">23</span></a> or the Jensen et al. cohorts<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">24</span></a> (8% and 9.8%, respectively). In relation to the GFR, other major studies such as the INSIGHT<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">25</span></a> and the ALLHAT<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">26</span></a> found a higher prevalence of GFR<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> (29% and 17.7%, respectively) than our data (14%). This fact could be in relation to a higher average age, diabetes rate and the inclusion of patients with CVD in these larger epidemiological studies.</p><p id="par0100" class="elsevierStylePara elsevierViewall">After excluding patients with TOD detected by the first set of four tests, we suggest performing a carotid ultrasound examination for the estimation of the IMT and the presence of carotid plaques, since it detected the biggest proportion of TOD in our population at this point. With this second step, we managed to identify a 32.7% more patients with TOD, and properly classify 89% of the population. In other words, after those two consecutive analyses, only 11% of the individuals without TOD would end-up having TOD after a complete workup. Interestingly, the carotid ultrasound showed the greatest discriminatory capacity in our cohort since it found a pathological result in 48% of the individuals. The variability of the data published is wide. The Dutch metaanalysis found 1–12% of pathological carotid ultrasound in the general population,<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">7</span></a> while the APROS study found 27.4% in a hypertensive cohort,<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">27</span></a> and the Monteiro cohort reported up to 75%.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">28</span></a> The lack of homogeneity of the samples within each cohort as well as the ultrasound protocol used could explain the differences.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Based on our results we propose the PWV measurement as the next diagnostic tool, contributing altogether to properly classify up to 96% of our population. The overall rate of abnormal PWV in our cohort was 32.6%. Sehestedt et al. reported a prevalence of PWV pathological values of 23.6% in his cohort of 1968 patients free of CVD or diabetes,<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">4</span></a> a difference possibly due to the lower cut-off point we used (10<span class="elsevierStyleHsp" style=""></span>m/s) and the non-inclusion of normotensive patients. The authors showed that they were able to detect 70% of the TOD of their sample by measuring the PWV and ACR. With these two tests, we could only identify 39%. It is important to notice that Sehestedt screened their population using only 4 tests (ECO, the presence of carotid plaque, PWV and ACR) whilst we used up to 7 diverse tests. According to our findings, it cannot be excluded a real higher proportion of TOD than the one reported by Sehestedt.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The test that yielded the least positive results was the ECO, which identified an additional 18% of TOD after IMT and PWV measurements in our sample. In our cohort, the prevalence of ECO-LVH was 19.9%, which is in contrast with other studies such as the APROS (36.9%).<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">27</span></a> The LVH detection protocol, the absence of any antihypertensive treatment and a worse blood pressure control in that study could explain our lower rates of LVH. We consider the ECO being of relatively low importance in our algorithm due to the following reasons: (1) a lower LVH prevalence in our cohort, (2) the fact that we performed a more complete coverage of organ damage including four target territories, and (3) our design of initial set of four widely available tests identified a significant amount of patients with TOD from the very beginning.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Finally, we would like to stress an extremely high variability of both clinicians and investigators when deciding the test to use in the search of silent TOD. In this sense, a French group evaluated the frequency of the use of the distinct tools available for TOD detection in 2730 hypertensive patients without CVD.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a> Only 49–63% of the participating clinicians actively searched for TOD in at least 3 target organs and 6–9% of the participating doctors did so in all target territories. The current evidence points out that the ECG is performed in the majority of the hypertensive population (up to 98%<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">9</span></a>), while the carotid ultrasound is only assessed in 5–24% of the cases.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">8,9</span></a> This fact is undoubtedly related to the limited availability of the latter, the costs and the lack of official guidelines for its use. The current findings add substantially to the theoretical exploratory pathway that yields the most at the lowest cost.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The findings from this study make several noteworthy contributions to the current literature. In a non-selected cohort of hypertensive patients without CVD, the determination of the carotid ultrasound in the first step, the PWV measurement in a second and lastly the LVH determination by the ECO may be applied as a search strategy for a silent TOD, once the most accessible and available tests have been carried out without success. This strategy ended-up detecting 100% of the TOD present in the sample, issue that could carry major implications in the treatment and management of the hypertensive patient.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Limitations</span><p id="par0125" class="elsevierStylePara elsevierViewall">There are a number of limitations that need to be considered. First, the sampling was non-probabilistic and the sample size was relatively small and precluded, for instance, a cross-sectional validation of the protocol. In addition, the proportion of detected TOD could have been influenced by the sample size. However, the population included is representative of the hypertensive population in this country, with similar proportion of baseline characteristics (gender, age, body mass index, average blood pressure, cholesterol and glucose levels) than those found in large descriptive studies of the hypertensive population in our country such as the PRESCAP<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">29</span></a> and the CONTROLPRES.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a> Nevertheless, it is a fact that our results cannot be generalized to recently diagnosed young hypertensive patients, due to the fact we only included treated patients with long duration of hypertension. Secondly, the cross-sectional design of our protocol precludes the definition of the prognostic implications of each form of TOD. Defining the relative importance in terms of prognosis of each form of TOD could modify the current search strategy since tests with greater prognostic value probably should be performed first. Thirdly, one source of weakness in this study is that the sample included 15% of diabetic patients, in which the presence of TOD could harbour a different implication. We deliberately included diabetic individuals with the aim of evaluating the search strategy irrespectively of the presence of diabetes. Another important limitation is the rate of complementary explorations that could not be calculated or interpreted in the sample. Also, we did not investigate in-depth the presence of cerebral CVD, due mainly to the need for expensive explorations that would have required the use of potentially nephrotoxic contrast. These facts, could have underestimated the prevalence of TOD and CVD in the present study. Besides, we acknowledge the low sensitivity of the criteria used to diagnose LVH by the ECG. The ECG was performed at the primary care facilities with ECG recorders that did not provide the required automatic data for the calculation of more sophisticated ECG criteria. Finally, the eye fundus was not examined in order to exclude retinal microvascular abnormalities since grade I and II retinal changes do not add prognostic information<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a> and the prevalence of advanced retinopathy is extremely low in such patients.<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">31,32</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusions</span><p id="par0130" class="elsevierStylePara elsevierViewall">The prevalence of silent TOD is high among asymptomatic hypertensive patients without overt CVD. The TOD searching strategy is controversial and no general rules have been delivered by any Clinical Guideline about when and how a search for TOD should be undertaken. We put forward a novel diagnostic algorithm that could be used as an instrument to systematize the search for TOD. We hereby reference the ECG, the GFR, the ACR and the ABI that are easily available and should be systematically used in both primary care and hospital environments. Hereafter, we highlight a step-by-step strategy in which an ultrasound for carotid TOD diagnosis (IMT and presence of plaque) yields the highest proportion of positive results and, thus, should be used first. In undetected cases however, the implementation of a PWV and an echocardiogram (when needed) identified a 100% of the TOD in our population.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Ethical disclosures</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Protection of human and animal subjects</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Confidentiality of data</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work centre on the publication of patient data.</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Right to privacy and informed consent</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Funding</span><p id="par0150" class="elsevierStylePara elsevierViewall">There has not been any kind of support for the elaboration of this work.</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Conflicts of interests and financial disclosures</span><p id="par0155" class="elsevierStylePara elsevierViewall">There is no actual or potential conflict of interest, including any financial, personal or other relationships with other people or organizations, that could inappropriately influence, or be perceived to influence, the present manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres927605" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec903015" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres927606" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec903016" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design study and population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Anamnesis, physical examination and blood pressure measurement" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Systematic search strategy for TOD" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Considerations for the algorithm for silent TOD detection" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0040" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Baseline characteristics of the population" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Presence of silent TOD" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Proposed algorithm for silent TOD detection" ] ] ] 7 => array:2 [ "identificador" => "sec0060" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0065" "titulo" => "Limitations" ] 9 => array:2 [ "identificador" => "sec0070" "titulo" => "Conclusions" ] 10 => array:3 [ "identificador" => "sec0075" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0080" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0085" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0090" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0095" "titulo" => "Funding" ] 12 => array:2 [ "identificador" => "sec0100" "titulo" => "Conflicts of interests and financial disclosures" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-01-31" "fechaAceptado" => "2017-04-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec903015" "palabras" => array:5 [ 0 => "Ambulatory blood pressure/home blood pressure monitor" 1 => "Hypertensive heart disease" 2 => "Hypertension-vascular disease" 3 => "Renal disease" 4 => "Risk assessment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec903016" "palabras" => array:5 [ 0 => "Medición ambulatoria de la presión arterial" 1 => "Cardiopatía hipertensiva" 2 => "Arteriopatía hipertensiva" 3 => "Nefropatía hipertensiva" 4 => "Estratificación de riesgo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the diagnostic potential of seven examinations in order to define the most suitable strategy for target organ damage (TOD) search in hypertensive patients.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This is a descriptive, cross-sectional study. 153 consecutive treated and essential hypertensive patients were enrolled. Patients with established cardiovascular or chronic renal disease (stage ≥4) were excluded. TOD search was assessed by: glomerular filtration rate (GFR), albumin/creatinine ratio (ACR), electrocardiogram (ECG), echocardiogram (ECO), ankle–brachial index (ABI), pulse wave velocity (PWV), and carotid ultrasound (intima media thickness and presence of plaques). The rationale of our strategy ought to determine the performance of applying a set of the most widely available tests (GFR, ACR, ABI, ECG) and advise about the optimal sequence of the remaining tests.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The sample was 64.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.9 years old, 45.8% males. 82.6% of the sample had any TOD at all. The resulting algorithm found a 37% TOD in relation to GFR, ACR, ABI and ECG values. Adding carotid ultrasound added up to 70% of the studied population and properly classified (TOD+/TOD−) 89% of the cohort. When performing PWV, 78% of the patients had been identified as TOD+ and 96% of the population was correctly identified. Contribution of ECO was minor.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">After running the more widely available explorations (GFR, ACR, ABI, ECG), a step-by-step strategy that included carotid ultrasound, PWV and ECO could be the best sequence for TOD search in asymptomatic hypertensive patients.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar el rendimiento diagnóstico de un panel de siete pruebas de determinación de daño de órgano diana (DOD) aplicadas de forma sistemática, a fin de sugerir la estrategia óptima para la búsqueda de DOD en el hipertenso.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo y transversal. Se incluyeron 153 pacientes diagnosticados de hipertensión esencial bajo tratamiento farmacológico. Se excluyeron pacientes con enfermedad cardiovascular establecida o enfermedad renal crónica estadio ≥4. Se realizó una búsqueda de DOD mediante filtrado glomerular estimado (FGe), índice albúmina creatinina (IAC), hipertrofia ventricular por electrocardiograma (ECG) y ecocardiograma (ECO), índice tobillo brazo (ITB), velocidad de la onda de pulso (VOP) y ecografía carotídea (placas y grosor íntima media). Se propuso una estrategia de búsqueda de DOD en la que tras la realización de las exploraciones más accesibles (FGe, IAC, ITB y ECG) se sugiere la secuencia de exploraciones a realizar con mayor eficacia diagnóstica.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La edad media fue 64.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.9 años, siendo el 45.8% varones. El 82.6% presentó algún tipo de DOD. Según el algoritmo propuesto, las pruebas de mayor accesibilidad diagnosticaron un 37% de DOD en la muestra. Tras añadir la ecografía carotídea, se detectó DOD en el 70%, y el 89% de la población fue apropiadamente clasificada en DOD+/DOD−. La realización de VOP incrementó la prevalencia de DOD hasta el 78%, y el 96% de la muestra fue correctamente clasificada. La contribución de la ECO fue menor.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Tras la realización de las exploraciones más accesibles (FGe, IAC, ITB y ECG), la realización sistemática de ecografía carotídea, VOP y ECO podría ser la estrategia óptima para la búsqueda de DOD en el hipertenso.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2557 "Ancho" => 2083 "Tamanyo" => 257412 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Proposed algorithm for the diagnosis of silent target organ damage. The parentheses on the right show the ratio of patients in whom TOD is detected at each step. ECG: electrocardiogram; GFR: glomerular filtration rate; LVH: left ventricular hypertrophy.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1260 "Ancho" => 1625 "Tamanyo" => 99254 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Relative proportion of patients with identified target organ damage at each step of the diagnostic algorithm. TOD: target organ damage.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">HDL: high density lipoprotein; LDL: low density lipoprotein.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristic \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Systolic blood pressure, mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">136<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diastolic blood pressure, mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Time of diagnosed hypertension, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Number of antihypertensive drugs/patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Body mass index, kg/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Waist circumference in men (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Waist circumference in women (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total cholesterol, mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">203.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>32.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDLc, mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">120<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>29.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HDLc, mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Triglycerides, mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">142.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>75.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fasting glucose, mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">105.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>21.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Serum creatinine, mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.86<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.23 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1564686.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of the cohort.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">ACE: angiotensin-converting-enzyme.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Drug \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diuretics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82 (53.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Beta-blockers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 (39.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Calcium channel antagonists \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 (34) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ACE inhibitors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (34.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Angiotensin receptor antagonists \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (49) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alpha blockers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (10.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Central action sympatholytic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1564685.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Antihypertensive pharmacologic treatment.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">GFR: glomerular filtration rate; IMT: intimae media thickness; LVH: left ventricular hypertrophy; ABI: ankle–brachial index; LV: left ventricle; PWV: pulse wave velocity</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Examination test \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Mean (±standard deviation)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>GFR, ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.39 (±21.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LVH voltage Cornell, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.1 (±5.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LVH voltage Sokolow-Lyon, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (±6.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LV mass, echocardiogram, men, g/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.8 (±24.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LV mass, echocardiogram, women, g/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.1 (±17.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IMT, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 (±0.18) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ABI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (±0.17) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PWV, m/s \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.5 (±2.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Medium (p25;p75)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Albumin/Creatinine ratio, mg/g \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.8 (1.9;14.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Number of individuals (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Presence of carotid plaque \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 (±35.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1564688.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Results from the complementary exploratory tests.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">ECG: electrocardiogram; ECO: echocardiogram; GFR: glomerular filtration rate; IMT: intimae media thickness; LVH: left ventricular hypertrophy; ACR: albumin/creatinine ratio; ABI: ankle–brachial index; PWV: pulse wave velocity. Data are presented as percentages and 95% confidence interval (CI), calculated with the Wilson method.</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Most advisable strategy in search of asymptomatic target organ damage in hypertensive patients.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TOD type and complementary exploratory tests \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pathological result, <span class="elsevierStyleItalic">n</span> (%, 95% CI) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Renal TOD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (22.7, 16.7–30.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pathological GFR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (14.0, 9.3–20.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pathological ACR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (15.0, 9.8–22.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cardiac TOD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (25.0, 18.8–32.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LVH with ECG (≥1 criteria) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (9.7, 5.8–15.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LVH with ECO \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (19.9, 14.2–27.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Carotid TOD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 (48.0, 40.0–56.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pathological IMT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (23.6, 17.5–31.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Carotid plaque \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 (37.2, 29.8–45.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Vascular TOD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 (37.9, 30.6–45.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pathological ABI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (16.3, 11.1–23.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pathological PWV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (32.6, 25.4–40.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1564687.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Number (and relative proportions) of patients diagnosed with silent target organ damage (TOD).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0165" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estimation often-year risk of fatal cardiovascular disease in Europe: the SCORE project" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.M. 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Original article
Most advisable strategy in search of asymptomatic target organ damage in hypertensive patients
Estrategia óptima de búsqueda de daño de órgano diana asintomático en el hipertenso