Guidelines for antihypertensive therapy: problems with a strategy based on absolute cardiovascular risk

The CONTROLRISK study was designed to determine the cardiovascular risk profile of the hypertensive population attended at primary care and specialist setting in Spain and to investigate whether physicians stratify the risk correctly, according to the 2003 European guidelines. A total of 8920 patients were recruited from primary care (n ¼ 4485) and specialist outpatient clinic (n ¼ 4435). The age criteria was 62.6711.1 years; 51.6% were women. No differences were observed in the severity of hypertension. More than 85% presented other cardiovascular risk factors, similarly in both groups. Target organ damage (TOD) and associated clinical conditions (ACC) were more frequent in specialist setting (57.6 vs 34.3% and 39 vs 28.7%, both Po0.0001). The most common risk factor was age. The most frequently reported TOD was left ventricular hypertrophy (42.3 and 22.1%; Po0.0001).Ischemic heart disease was the most common ACC (21.5 vs 13.1%; Po0.0001). The risk profile was significantly higher in specialist population (75.1 vs 60.3% of patients belonged to high-or very high-risk groups). Specialists and primary care physicians stratified only 54.6 and 48% of their patients correctly, respectively (Po0.05). Both, specialists and general practitioners (GPs) strongly underestimated the risk. Very high-risk patients were adequately assessed only in 44.9% of cases by specialists and in 25.3% by GPs (Po0.001). More than half of the hypertensive patients attended by GPs in Spain belong to the high-or very high-risk groups. GPs and specialists tend to underestimate the cardiovascular risk in daily clinical practice, mainly in very high-risk patients.

Section: Test For Sex and Bmi Distributionmentioning

confidence: 99%

Cardiovascular risk profile and risk stratification of the hypertensive population attended by general practitioners and specialists in Spain. The CONTROLRISK study

Barrios

Escobar

Calderón³

et al. 2007

“…Using this age/sex reference to guide individual treatment may mean more aggressive treatment of the middle-aged, compensating for over-reliance on using an absolute risk index in isolation. 6 Conversely, in those with uncontrolled hypertension, although there were significant differences between the age groups, there was no linear relationship between increasing age and the proportion of individuals with a reduced risk when compared to their age/sex standard.…”

Section: Discussionmentioning

confidence: 91%

“…5 There are, however, misgivings about adopting an uncritical approach based on absolute risk when managing high BP. 6,7 Firstly, there is concern that absolute benefits are calculated from short term randomised controlled trials. Such an approach may over emphasise absolute benefits in the elderly at the expense of lifetime/actuarial benefit in the 3.5-87.8%) and increasing absolute risk was significantly associated with age.…”

Section: Introductionmentioning

confidence: 99%

“…The resulting index of risk being known as the marginal risk. 6,9 The consequence of taking a risk-based approach is that the number and category of individuals eligible for treatment will change, depending of what approach to risk is taken. 9 Until now, discussion about using a reference age/sex absolute risk standard and the calculation of marginal risk has been focused on newly diagnosed hypertensive patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Reconciling different measures of risk in the treatment of hypertension: a community-based study

Fahey

Peters

1998

Background: There is disagreement as to how cardiovascular risk in hypertensive patients should be measured. In particular, whether absolute risk measurement alone is a realistic index on which to base treatment goals. Method: A cross-sectional study on 895 treated hypertensive patients in 18 general practices in the UK. Reporting on the distribution and magnitude of agespecific absolute risk. The percentage of individuals with controlled hypertension whose absolute risk exceeds their age/sex absolute risk standard and the percentage of individuals with uncontrolled hypertension whose risk is less than their age/sex absolute risk standard. Results: Overall, 62.8% (95% CI 59.6-66%) individuals had an absolute risk that exceeded 20% over 10 years. The magnitude of absolute risk was considerable (range

“…The use of shortterm absolute risk to determine therapy therefore requires review and modification. 39 One approach when dealing with younger patients at high relative but low absolute risk is to evaluate risk levels as if the patient was 60 years of age and treat on that basis.…”

Section: Relative and Absolute Riskmentioning

confidence: 99%

Benefits and pitfalls of cardiovascular risk assessment

2000

One of the most important challenges facing modern preventative medicine is the problem of how best to identify and treat those at highest risk of developing cardiovascular disease, for whom appropriate management (ranging from lifestyle modification to therapeutic regimens) can improve both duration and quality of life. The use of risk assessment can contribute greatly to identifying those individuals who will benefit from riskreducing interventions. However, assessment tools