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Can we stratify risk to guide therapy.

M H Alderman1

  • 1Albert Einstein College of Medicine, Dept. of Epidemiology & Social Medicine, Bronx, NY 10461, USA.

Clinical and Experimental Hypertension (New York, N.Y. : 1993)
|July 28, 1999
PubMed
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Absolute cardiovascular disease (CVD) risk, not just blood pressure, should guide antihypertensive treatment decisions. Stratifying patients by CVD risk optimizes therapy intensity for better event prevention.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Clinical Pharmacology

Background:

  • Blood pressure is directly related to cardiovascular disease (CVD) risk.
  • Blood pressure alone is an insufficient predictor of CVD events.
  • Multiple risk factors significantly alter CVD event expectations even with similar blood pressure levels.

Purpose of the Study:

  • To emphasize the importance of absolute CVD risk over blood pressure levels in guiding antihypertensive treatment.
  • To highlight the limitations of conventional antihypertensive therapy in preventing expected events.
  • To introduce a risk stratification scheme for modulating therapy intensity.

Main Methods:

  • Analysis of observational data from long-term treated patients.
  • Development of a pre-treatment CVD risk stratification scheme.

Related Experiment Videos

  • Consideration of specific risk factors influencing drug selection.

    • Main Results:

    • Absolute CVD risk, incorporating factors like smoking, cholesterol, diabetes, and existing CVD, provides superior discrimination of event risk compared to blood pressure alone.
    • Conventional treatments prevent only a fraction of expected CVD events.
    • Risk stratification allows for tailored antihypertensive therapy intensity to maximize CVD prevention.

    Conclusions:

    • Antihypertensive treatment decisions should be based on absolute CVD risk stratification, not solely on blood pressure readings.
    • Risk stratification enables personalized modulation of therapy intensity for improved CVD prevention.
    • Individual risk factors can guide the selection of specific antihypertensive medications.