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Coronary risk versus cardiovascular risk for treatment decisions in mild hypertension
Wilfred W Yeo1, Karen Rowland Yeo
1Clinical Pharmacology & Therapeutics, Division of CLinical Sciences (S), University of Sheffield, UK. w.w.yeo@sheffield.ac.uk
Insights
A 15% 10-year coronary heart disease (CHD) risk threshold accurately identifies men but misses nearly half of women needing mild hypertension treatment for cardiovascular disease (CVD) risk. This highlights a gap in current cardiovascular risk assessment for women.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- British guidelines suggest treating mild hypertension at a 20% 10-year cardiovascular disease (CVD) risk.
- Current treatment targets a 15% 10-year coronary heart disease (CHD) risk equivalent.
- The study investigates the relationship between CHD and CVD risk in mild hypertension patients.
Purpose of the Study:
- To examine the relationship between 10-year CHD and CVD risk in men and women with mild hypertension.
- To assess the accuracy of using a 15% 10-year CHD risk threshold for identifying individuals with a 10-year CVD risk of 20% or higher.
Main Methods:
- Cross-sectional survey conducted in England in 1998.
- Identified 5588 adults aged 35-74 years free of cardiovascular disease.
- Used Framingham functions to estimate 10-year CHD and CVD risk for 1364 individuals with mild hypertension.
Main Results:
- At a 15% 10-year CHD risk, 10-year CVD risk was 20-21% for younger individuals and 24-25% for older individuals.
- Using a 15% CHD risk threshold showed high specificity (>96%) for identifying CVD risk >= 20%.
- Sensitivity varied by sex and age, with lower sensitivity (47%) in older women.
Conclusions:
- A 15% 10-year CHD risk threshold is reasonably accurate for identifying men eligible for hypertension treatment.
- This threshold misses approximately 50% of women who meet the criteria for antihypertensive treatment based on CVD risk.
- Current risk assessment strategies may underestimate CVD risk in women with mild hypertension.
Background:
British guidelines recommend treatment for mild hypertension at a cardiovascular (CVD) risk threshold of 20% over 10 years. However, treatment is targeted at the equivalent coronary (CHD) risk of 15% over 10 years. We examined the relationship between CHD and CVD risk in men and women with mild hypertension and assessed the accuracy of using a 10-year CHD risk threshold of 15% to identify patients at a 10-year CVD risk > or = 20%.
Design:
Cross-sectional survey of England in 1998.
Methods:
We identified 5588 subjects aged 35-74 years free of cardiovascular disease with complete data for risk assessment. Of these, 1364 (24.4%) had mild hypertension (systolic pressure 140-159 mmHg or diastolic pressure 90-99 mmHg). The Framingham functions were used to estimate CHD and CVD event risk for each individual.
Results:
At a 10-year CHD risk of 15%, the corresponding 10-year CVD risk for men and women, respectively was 20% and 21% in those aged < 55 years, and 24% and 25% in those aged > or = 55 years. Using a 10-year CHD risk threshold of 15% to identify patients at a 10-year CVD risk > or = 20% had high specificity (>96%) in all four groups. For men and women respectively, the sensitivity was 73% (62-84%) and 62% (35-88%) in younger subjects, and 89% (85-93%) and 47% (38-56%) in older subjects.
Conclusion:
Using a 10-year CHD risk of 15% to target patients at a 10-year CVD risk > or = 20% was reasonably accurate for men but missed about 50% of women eligible for antihypertensive treatment.