METHODS
Subjects and Study Design
The patients in the study were prospectively recruited from the department of cardiology and geriatrics at Khanh Hoa
Hospital in Vietnam between May 2000 and May 2001. The cross-sectional study included 258 patients older than 60
(140 male and 118 female, mean age: 70.37±7.69) with hypertension as defined according to the 1999 WHO/ISH criteria.
The diagnosis of hypertension was based on the average of two or more readings taken at each of two and more visits
after the initial screening of systolic blood pressure (SBP) equal or above 140 mmHg and/or a diastolic blood pressure
(DBP) of 90 mmHg or more. Isolated systolic hypertension (ISH) is defined as a SBP of 140mmHg or more and a DBP of less
than 90 mmHg. The blood pressure (BP) was measured at rest on the right arm by a physician or a trained nurse with a
mercury sphygmomanometer, with the patient sitting and his/her arm supported at level of heart. All patients with
secondary hypertension were excluded.
Risk Factor Assessment
All subjects were evaluated for risk factors by answering a standard questionnaire and undergoing a complete clinical
examination. Body weight and height were recorded. Body mass index (BMI) was computed as weight divided by height squared.
An electrocardiogram at rest and blood samples were obtained after an overnight fast and analyzed for total cholesterol,
high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, glycemie,
and creatinine by the Cobas Miras apparel (Roche, Germany). . If the total cholesterol level was >2g/l, HDL-C > 35mg/dl,
LDL-C > 130mg/dl and glucose > 126mg/dl, a second blood sample was taken to confirm the diagnosis of hypercholesterolemia
or diabetes mellitus.. The Risk assessment was calculated according to the criteria of 1999 WHO/ISH. All subjects were
evaluated for target organ damage, other cardiovascular risk factors, and conditions that may influence treatment.
The severity of hypertension was classified as grade I, grade II and grade III. Other factors influencing prognosis
include A/Risk factors: men > 55 years, women> 65 years, cigarette smoking, total cholesterol >6.5 mol/l, diabetes
mellitus, family history of premature of CVD. B/ Target organ damage: left ventricular hypertrophy (electrocardiogram,
echocardiography, chest X-ray), proteinuria with slight elevation serum creatinine, atherosclerotic plaque by
ultrasound/ X-ray, retinopathy (grade II). C/ Associated clinical conditions: Cerebrovascular disease, heart disease,
renal disease, vascular disease, advanced retinopathy. The stratification of patients by absolute level of cardiovascular
risk is showed in Table 2.
Table 2 Stratifying risk to quantify prognosis
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