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Risk stratification by guidelines compared with risk assessment by risk equations applied to a MONICA sample
Mats Persson1, Bo Carlberg, Lars Weinehall
1aDepartment of Public Health and Clinical Medicine and bDepartment of Mathematical Statistics, University of Umeå, Sweden. mats.presson@fammed.umu.se
Journal of Hypertension
|June 5, 2003
Summary
The 1999 World Health Organization/International Society of Hypertension (WHO/ISH) guidelines for hypertension risk stratification are inaccurate for medium and high-risk patients. Statistical risk equations provide a more individualized cardiovascular disease (CVD) risk assessment.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The World Health Organization/International Society of Hypertension (WHO/ISH) Hypertension Guidelines (1999) offer a risk stratification scheme for cardiovascular disease (CVD).
- Statistical risk equations represent an alternative method for predicting cardiovascular risk.
Purpose of the Study:
- To compare the accuracy of the WHO/ISH Hypertension Guidelines risk stratification with statistical risk equations in individuals with high blood pressure.
- To evaluate discrepancies in cardiovascular risk prediction between the two methods.
Main Methods:
- Utilized data from three population surveys (1986, 1990, 1994) in northern Sweden (NSW) to develop a 10-year cardiovascular risk equation.
- Applied the 1999 WHO/ISH risk stratification scheme to a 1999 MONICA sample (n=5997).
- Compared WHO/ISH risk stratification with risk predictions from NSW MONICA and Framingham risk equations.
Main Results:
- Good agreement was observed between methods when risk equation values were averaged per guideline risk group.
- Poor agreement was found for individual risk predictions in medium and high-risk groups.
- Many individuals had higher or lower predicted risks than indicated by the WHO/ISH guidelines, despite similar average population risk.
Conclusions:
- The 1999 WHO/ISH Hypertension Guidelines demonstrate insufficient accuracy and detail for medium- and high-risk patients.
- The identified inaccuracies may have significant clinical implications, particularly for the medium-risk group.