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[Guidelines for pharmacological primary prevention of cardiovascular diseases--who should be treated?]
Atle Fretheim1, Arild Bjørndal, Andrew D Oxman
1Brannstasjonen legesenter Arendalsvei 26a 4898 Grimstad. atle.fretheim@shdir.no
Insights
New hypertension and hypercholesterolemia guidelines emphasize absolute cardiovascular disease risk for initiating drug treatment. A 20% risk threshold is suggested, with uncertain effects in older adults.
Area of Science:
- Cardiology
- Public Health
- Evidence-Based Medicine
Background:
- Existing hypertension and hypercholesterolemia guidelines vary in quality and clarity.
- A need exists for guidelines developed using systematic and explicit methods.
- This study introduces a new set of evidence-based recommendations.
Purpose of the Study:
- To develop new clinical practice guidelines for hypertension and hypercholesterolemia treatment.
- To establish clear, evidence-based recommendations for patient management.
- To improve the quality and transparency of guideline development.
Main Methods:
- Systematic literature searches were conducted across multiple databases.
- Recommendations were formulated based on critical appraisal of evidence.
- Guidelines were refined through physician panel discussions and iterative revisions.
- Feedback was solicited from professional, governmental, and patient organizations.
Main Results:
- Absolute cardiovascular disease risk is proposed as the primary factor for initiating drug therapy.
- A 20% 10-year risk of angina or myocardial infarction is suggested as a treatment threshold.
- The efficacy of antihypertensives in individuals over 80 and cholesterol-lowering drugs in those over 70 remains uncertain.
- Treatment for blood pressure exceeding 170/100 mm Hg is recommended regardless of cardiovascular risk.
Conclusions:
- Patient discussion regarding drug treatment should be guided by absolute cardiovascular disease risk.
- Specific risk thresholds can inform decisions on initiating pharmacological interventions.
- Uncertainty exists regarding the benefits of certain treatments in elderly populations.
- High blood pressure levels warrant treatment irrespective of overall cardiovascular risk.
Background:
Several clinical practice guidelines for the treatment of hypertension and hypercholesterolaemia are available. The quality of these guidelines varies and the basis for their conclusions is often not clear. We have used systematic and explicit methods in the development of a new set of recommendations. This is the first of three articles describing these guidelines.
Material And Methods:
Evidence was found by a systematic search in databases and reference lists in guidelines and articles. A set of recommendations was prepared based on a critical appraisal of the literature. These recommendations were revised through discussions with a panel of physicians and agreed upon after several iterations. The guidelines were circulated to professional, governmental and patient organisations, with a request for feedback on errors or shortcomings.
Results And Interpretation:
The absolute risk of cardiovascular disease should be used as the basis for discussing with a patient whether drug treatment should be initiated. A 20% risk of developing angina or myocardial infarction over the next ten years is a reasonable threshold for considering treatment. The effects of antihypertensives for persons older than 80 years and of cholesterol-lowering drugs for persons older than 70 years are uncertain. Treatment of blood pressure above 170/100 mm Hg is recommended independent of the risk of cardiovascular disease.