Societies CVD risk-assessment programme/chart. Optimal cholesterol lowering should reduce the total cholesterol by 25% or LDL-cholesterol by 30% or achieve a total cholesterol of o4.0 mmol/l or LDL-cholesterol of o2.0 mmol/l, whichever is the greatest reduction (A). Glycaemic control should be optimised in people with diabetes, for example, HbA1c o7% (A). Advice is provided on the clinical management of hypertension in specific patient groups, that is, the elderly, ethnic minorities, people with diabetes mellitus, chronic renal disease, and in women (pregnancy, oral contraceptive use and hormone-replacement therapy). Suggestions for the improved implementation and audit of these guidelines in primary care are provided.

The prevalence of cardiovascular disease and hypertension show wide variability among different ethnic groups in the UK. We combined data collected annually between 1991-1996 in the Health Surveys for Englandnationwide surveys that provide information on the health status in a representative sample of the population living in England, to compare blood pressure (BP) levels, hypertension rates (systolic BP у160 mm Hg or diastolic BP у95 mm Hg, or those on antihypertensive medication), hypertension treatment and control rates in people of white, black (combining black-Caribbean, black-African and black-other), and South Asian origin (combining Indians, Pakistanis and Bangladeshis). Analyses were stratified into two age groups, 16-39 (younger) and у40 years (older), but were focused on older adults (30 619 whites, 295 blacks and 529 South Asians).Age-adjusted mean BP levels and hypertension rates

ObjectiveHigh blood pressure is a major risk factor for cardiovascular disease and concerns have been raised over its possible association with antiretroviral drugs. The objective of this study was to explore the associations among blood pressure, HIV status and two predefined highly active antiretroviral therapy (HAART) regimens: treatment with and without nonnucleoside reverse transcriptase inhibitors (NNRTIs) (NNRTI-and non-NNRTI-based HAART). MethodA cross-sectional survey was conducted among 612 adults attending the Sexual Health Outpatient Department at St Mary's NHS Hospital Trust, London. ResultsHIV-infected patients treated with NNRTIs had a blood pressure that was 4.6/4.2 mmHg higher than those who were HIV positive but treatment naïve. The diastolic difference remained statistically significant after adjusting for potential confounders of this association (2.4 mmHg; P 5 0.03). There was no difference in blood pressure between those treated with non-NNRTI-based regimens and those who were HIV positive but treatment naïve. ConclusionNNRTIs may be associated with an increase in blood pressure. Pending further more robust evidence from randomized clinical trials it would be prudent for clinicians to monitor blood pressure in all HIV-infected patients, particularly after initiating treatment with NNRTIs, and to commence antihypertensive therapy whenever appropriate. IntroductionDeaths from AIDS have declined dramatically since the introduction of highly active antiretroviral therapy (HAART) in patients infected with HIV [1]. However, the incidence of myocardial infarction has increased fourfold and cardiovascular disease is now one of the major causes of death in HIV-infected patients in Western industrialized countries [2,3]. Anecdotal reports from the Peart-Rose (hypertension) Clinic at St Mary's NHS Hospital Trust, Paddington, London, raised awareness of an increasing number of young HIV-positive adults being referred with hypertension, a major risk factor for cardiovascular disease. This raised the possibility that HIV and/or its treatment may be associated with raised blood pressure. However, the published evidence concerning these associations is both limited and conflicting [4][5][6][7][8][9][10][11][12][13][14][15]. While the current studies do provide useful insights into a potentially emerging problem, methodological problems, including the choice of control group [4][5][6][7][8][9][10], inadequate blood pressure measurement [11][12][13][14][15] and crude categorical outcome measures [4,5,7,14,15], may have generated bias and confounded results. Another potential problem is the consideration of HAART as a single entity, despite it being an umbrella term for different combinations of antiretroviral drugs [4,5,11,[13][14][15] Methods Study populationPatients eligible for inclusion in this cross-sectional survey were those attending routine appointments at the Sexual Health Outpatient Department at St Mary's NHS Hospital Trust, Paddington, London, between September 2005 and September 2006 and who ...