Concepts of multiple risk factors management: the Gubbio study

Treatment of hypertension has been one of the greatest medical successes of the last 30 years, but it has also suffered numerous drawbacks. These have probably arisen through failing to place antihypertensive treatment in the frame of a multiple strategy directed to the control of all major risk factors for cardiovascular disease. Indeed, there is increasing evidence from most of the controlled trials that treatment of hypertension is significantly less successful in smokers than in non-smokers, and in patients with elevated than in patients with normal plasma cholesterol. Consequently, when it was decided to start a new study on the epidemiology of hypertension in the town of Gubbio in Central Italy, the study was planned as one on the epidemiology of all established cardiovascular risk factors, with the primary target of determining how often various risk factors are simultaneously present in individuals within a typical and homogeneous community in Central Italy.