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1999 WHO/ISH Guidelines applied to a 1999 MONICA sample from northern Sweden
Mats Persson1, Bo Carlberg, Tom Mjörndal
1Family Medicine, Department of Public Health and Clinical Medicine, 901 87 University of Umeå, Sweden. mats.persson@fammed.umu.se
Insights
Many hypertensive patients are undertreated, with a high incidence of elevated blood pressure. Applying WHO/ISH guidelines reveals that lowering blood pressure targets primarily impacts low- and medium-risk groups, highlighting the need for personalized hypertension management.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Hypertension is a major cardiovascular disease (CVD) risk factor.
- Drug treatment is cost-effective, but risk stratification is crucial for optimal indication.
- WHO/ISH guidelines provide a risk stratification scheme for CVD based on blood pressure and risk factors.
Purpose of the Study:
- To assess the impact of the WHO/ISH risk stratification scheme on a Swedish population sample.
- To evaluate indications for treatment and target blood pressure.
- To analyze the distribution of cardiovascular risk in the studied population.
Main Methods:
- Risk classification of 6000 subjects using a computer program based on WHO/ISH guidelines.
- Analysis of blood pressure levels, treatment status, and risk group distribution.
- Evaluation of the effect of shifting target blood pressure to <130/85 mmHg for subjects under 60.
Main Results:
- 15% of subjects had drug-treated hypertension, with 75% inadequately controlled.
- 30% of untreated subjects had blood pressure ≥140/90 mmHg, distributed across risk groups.
- Lowering the target blood pressure to <130/85 mmHg for those under 60 increased inadequately treated individuals, mainly in low- and medium-risk groups.
Conclusions:
- Only one-fifth of treated hypertensive patients achieved adequate blood pressure control.
- A high incidence of newly detected elevated blood pressure was observed.
- The WHO/ISH guideline's lower target blood pressure (<130/85 mmHg) for individuals under 60 predominantly affects low- and medium-risk groups.
Background:
Treating hypertension with drugs is so far the most cost-effective way to reduce this important risk factor for cardiovascular disease (CVD). It is, however, important to determine absolute risk, and thereby estimate indication for drug treatment, in order to maintain a cost-effective drug treatment. WHO/ISH Hypertension Guidelines from 1999 propose a risk stratification for estimating absolute risk for CVD based on blood pressure and additional risk factors, target organ damage (TOD) and CVD.
Objectives:
We studied the consequences of applying the recent WHO/ISH risk stratification scheme to a MONICA sample of 6000 subjects from a geographically defined population in northern Sweden, regarding indications for treatment, target blood pressure and risk distribution.
Methods:
We have risk-classified each of these patients using a computer program, according to the WHO/ISH scheme. Data on TOD were not available.
Results:
In all, 917 (15%) had drug-treated hypertension. Three-quarters (n = 737) were inadequately treated, with blood pressure levels at or above 140 or 90 mmHg. 1773 (30% of 5997) untreated subjects had a blood pressure of 140/90 or above; 16% in the low-, 62% in the medium-, 8% in the high-, and 14% in the very-high-risk group. The corresponding risk-group pattern for the inadequately treated hypertensives (n = 737) was 5.5, 48.3, 11.1 and 35.2%, respectively. If we shifted the target blood pressure from below 140/90 to below 130/85 for drug-treated subjects under 60 (n = 278) the number of inadequately treated subjects increased by 34 (12.2% of 278); 14 in the low-risk group, 15 in the medium-risk group, and only five in the high- or very-high-risk groups.
Conclusions:
Only one-fifth of the drug-treated hypertensives were well controlled. Moreover, the incidence of newly detected blood pressure elevation was high. The majority of younger subjects with high blood pressure had low risk, but in those aged 45-54 this had already risen to a medium risk. Changing the target blood pressure to below 130/85, for subjects aged below 60, as recommended by WHO/ISH, affects predominantly low- and medium-risk groups.