Guidelines for antihypertensive therapy: problems with a strategy based on absolute cardiovascular risk

Area of Science:

• Cardiology
• Public Health
• Pharmacotherapy

Background:

• Current guidelines recommend antihypertensive therapy based on a 10-year cardiovascular disease (CVD) absolute risk exceeding 20%.
• This approach disproportionately favors treating the elderly while potentially under-treating middle-aged individuals.

Purpose of the Study:

• To critically evaluate the current risk-based strategy for antihypertensive therapy selection.
• To propose an alternative approach incorporating age-adjusted risk and marginal hypertensive risk.

Main Methods:

• The paper presents a theoretical argument and critical analysis of existing risk stratification models for hypertension.
• It discusses the implications of using a single time-frame for risk assessment across all age groups.

Main Results:

• A uniform 10-year risk threshold may lead to suboptimal treatment allocation, overemphasizing the elderly and under-treating the middle-aged.
• Focusing on marginal hypertensive risk, the component of CVD risk attributable to elevated blood pressure, may offer a more targeted approach.

Conclusions:

• The current absolute risk model for antihypertensive therapy requires re-evaluation, particularly concerning its age-specific implications.
• An inverse age-related adjustment and consideration of marginal hypertensive risk are suggested for more equitable and effective treatment selection.
• Further research and testing are needed before widespread adoption of any revised risk-based policy.