The impact of plasma high-sensitivity C-reactive protein levels on cardiovascular risk stratification of hypertensive patients: results of the ICEBERG study

Abstract

The Intensive/Initial Cardiovascular Examination Regarding Blood Pressure Levels: Evaluation of Risk Groups (ICEBERG) study focused on the impact of high-sensitivity C-reactive protein (hs-CRP) measurement on cardiovascular risk evaluation. The ICEBERG study comprised 2 subprotocols. Each subprotocol had 2 patient profiles: patients previously diagnosed with essential hypertension and under medical treatment and patients with systolic blood pressure 130 mm Hg or higher, or diastolic blood pressure 85 mm Hg or higher, with no treatment for at least 3 months before inclusion. Measurement of hs-CRP and cardiovascular risk stratification were performed according to European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines. A total of 1817 patients were analyzed. In 1 group, the percentage of patients in "high" plus "very high" added-risk groups increased from 59.2% to 72.7% when hs-CRP data were added to routine serum biochemistries. In another, the increase was from 66.9% to 77.9%, whereas in a third group, it changed from 65.1% to 77.2%. The use of plasma hs-CRP levels might help in stratifying hypertensive patients into specific risk groups and modifying preventive approaches.

Figure 1

Distribution of patients in study groups into different blood pressure and plasma high‐sensitivity C‐reactive protein (hs‐CRP) levels. Blood pressure stratification was significantly different between study groups (P<.001 by Kruskal‐Wallis test). Group comparisons were as follows: P<.001 for treated referral group vs other groups; P=.001 for untreated referral vs untreated primary care groups.

Figure 2

The percentage of treated and untreated referral and untreated primary care patients in high plus very high added‐risk groups according to existing risk factors, plus history and physical examination and routine laboratory tests and plus hs‐CRP. P<.001 for history and physical examination and routine laboratory tests (gray bars) vs history and physical examination and routine laboratory tests plus hs‐CRP (black bars) (McNemar test).