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[Absolute risk and treatment decisions in hypertensive patients]
1INSERM 518 Département d'épidémiologie Faculté de médecine Toulouse-Purpan, Toulouse.
Insights
Assessing cardiovascular risk requires more than just classifying blood pressure as high or normal. Objective tools are crucial for accurately evaluating an individual's absolute risk, considering multifactorial elements beyond simple hypertension.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Risk Assessment
Context:
- Current clinical practice often dichotomizes blood pressure into hypertension or normotension, which doesn't fully capture cardiovascular risk.
- Cardiovascular risk is multifactorial, necessitating objective tools for individual absolute risk assessment.
- Established risk scores, like those from the Framingham study, require adjustments for different populations (e.g., in France) and have limitations in handling variables like age, tobacco use, and diabetes.
Purpose:
- To highlight the limitations of current clinical practices in cardiovascular risk assessment.
- To emphasize the need for objective tools to evaluate absolute cardiovascular risk in individuals.
- To discuss the challenges and strategies in applying risk assessment models in clinical decision-making.
Summary:
- The traditional hypertension/normotension dichotomy is insufficient for accurate cardiovascular risk assessment.
- Objective tools are essential for evaluating multifactorial absolute cardiovascular risk.
- Clinicians must be aware of the limitations of existing risk scores, including population-specific adjustments and variable handling (age, smoking, diabetes).
- Despite limitations, absolute risk evaluation aids in making informed treatment decisions for hypertension, moving beyond subjective approaches.
Impact:
- Promotes a more nuanced understanding of cardiovascular risk beyond simple blood pressure categories.
- Encourages the development and adoption of more accurate and individualized risk assessment tools.
- Aids clinicians in making more objective and evidence-based treatment decisions for hypertension and cardiovascular disease prevention.
Abstract:
The clinical practice, based on the dichotomy between hypertension or normotension, does not correspond to the actual risk due to blood pressure increase. Cardiovascular risk being multifactorial, it is necessary to have objective tools to assess the absolute risk in each individual. Presently, a 20% risk for the occurrence of a coronary event within a period of 10 years is the selected threshold. Clinicians must be aware of the numerous limits in the use of this risk rate. Risk estimates obtained from the Framingham study cannot be used in France without adjustments. Tobacco consumption and diabetes are variables expressed simply as present or absent, and age is a very significant and weighty factor. Different strategies have been proposed to take into account these shortcomings. Evaluation of the absolute risk in the decision to treat or not to treat hypertension is, in spite of its limits, an important help in avoiding a purely subjective clinical approach.