Milan Lović

Background. A precise estimate of cardiovascular (CV) risk in asymptomatic individuals is a key factor in the primary prevention of CV disease. Case report. In this report describe an asymptomatic individual presenting for CV status assessment. After the CV risk assessment using the SCORE risk charts and Framingham score, additional tests were performed, which provided better insight and reclassification of risk in this individual. Carotid Doppler sonography revealed plaques in the carotid arteries. Non-invasive assessment of coronary flow reserve (stress echocardiography test) demonstrated that a considerable area of the left ventricle is suffering ischemia when stressed. This was an indication for coronarography, which showed severe three-vessel coronary disease, that was later successfully treated by surgical revascularization. A year after the surgery a control stress echocardiography was performed, showing a satisfactory coronary flow reserve. Conclusion. A precise estimate of CV risk in asymptomatic individuals opens the road leading to early diagnosis, adequate therapy, and prevention of CV disease.

Hypertension with high cardiovascular (CV) risk is characterized by significant increase of one of the risk factors, especially cholesterol above 8 mmol/l in, for instance, familial hypercholesterolemia, or blood pressure (BP) ≥180/110 mmHg (stage III hypertension), diabetes mellitus, hypertensive left ventricular hypertrophy (LVH), moderate chronic renal failure with eGFR of 30-59 mL/min/1.73 m2 and/or calculated 10-year SCORE of 5-10%. Case report: We presented in this paper a patient with hypertension and high risk in whom diastolic hypertension, left ventricular hypertrophy, metabolic syndrome and obesity were predominant in the beginning, while diabetes mellitus prevailed in the further disease course. We presented the diagnostic protocol, as well as the risk assessment according to the European and American guidelines, and a proper selection of non-medicamentous and medicamentous therapy. The patient was treated and observed for 20 years, and the therapy based on the official hypertension guidelines was able to prevent major cardiovascular events and to suspend the progression of target organ damage in hypertension. Conclusion: Proper risk assessment in hypertensive patients, presence of risk factors and target organ damage have a decisive role in the selection of adequate therapy in hypertension. Achievement of target BP values, control of risk factors and regression of target organ damage constitute the basis of good quality of life of hypertensive patients and prevention of major cardiovascular events.