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[Pharmacological prevention of cardiovascular diseases in general practice]
E Meland1, H Ellekjaer, B Gjelsvik
1Institutt for samfunnsmedisinske fag, Universitetet i Bergen. Eivind.Meland@isf.uib.no
Insights
Primary preventive drug treatment is recommended for patients with elevated cardiovascular risk. Treatment is advised if ten-year risk exceeds 20% or blood pressure is 170/100 mmHg or higher, considering cost-effectiveness.
Area of Science:
- Cardiology
- Pharmacology
- Preventive Medicine
Background:
- The Norwegian College of General Practitioners' Working Group on Hypertension provides guidelines for primary preventive drug treatment of elevated cardiovascular risk.
- Recommendations are based on updated meta-analyses and randomized controlled trials, emphasizing the prevention of cardiovascular diseases.
Observation:
- Estimating total cardiovascular risk is crucial for initiating drug treatment.
- Drug treatment is recommended for patients with a ten-year risk exceeding 20% or blood pressure of 170/100 mmHg or higher.
Findings:
- Effective drug treatments include antihypertensive, antithrombotic, antidiabetic, and lipid-lowering medications with documented effects on hard endpoints.
- Specific drugs like aspirin, thiazides, beta-blockers, metformin, calcium blockers, ACE inhibitors, and statins have proven benefits, but their cost-effectiveness varies significantly.
Implications:
- Drug treatment should be recommended for individuals at significant risk of cardiovascular disease, utilizing medications with proven efficacy on morbidity and mortality.
- Cost considerations are integral to treatment decisions in managing cardiovascular risk.
Background:
In this paper the Norwegian College of General Practitioners, Working Group on Hypertension report recommendations for primary preventive drug treatment of elevated cardiovascular risk.
Material And Methods:
Updated metaanalyses and randomised controlled trials are the main basis for the recommendations. The purpose of treating hypertension is prevention of cardiovascular diseases. Drug treatment with documented effect on morbidity and mortality is therefore recommended. We have also evaluated the cost effectiveness of drug treatment.
Results:
An estimate of the total risk of future cardiovascular disease is a necessary basis for treatment decisions. This paper presents tools for estimating total cardiovascular risk. Drug treatment is recommended if ten-year risk exceeds 20% or blood pressure equals or exceeds 170/100 mmHg. Drug treatments include antihypertensive, antithrombotic, antidiabetic and lipid-lowering drugs with documented effect on hard endpoints. Aspirin, thiazides, betablockers, metformin, calcium blockers, ACE inhibitors and statins are all drugs with documented effects on significant endpoints, but the costs of these treatments differ substantially.
Interpretation:
Drug treatment to prevent cardiovascular disease should be recommended for patients at significant risk of cardiovascular disease. Drugs with documented effect on morbidity and mortality should be used. Considerations of costs are important in treatment decisions.