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A general practice-based study examining the absolute risk of cardiovascular disease in treated hypertensive patients
1Department of Social Medicine, University of Bristol.
Insights
Assessing cardiovascular disease absolute risk in hypertensive patients is crucial. Managing hypertension solely by blood pressure is unreliable for reducing cardiovascular risk.
Area of Science:
- Cardiovascular Medicine
- Hypertension Management
- Risk Stratification
Background:
- Current hypertension management often relies solely on attained blood pressure levels.
- Absolute risk assessment of cardiovascular events is advocated for judging anti-hypertensive therapy risks and benefits.
Purpose of the Study:
- To quantify the 10-year absolute cardiovascular disease risk in patients treated for hypertension in general practice.
- To identify risk factors associated with uncontrolled hypertension in this population.
Main Methods:
- Cross-sectional study of hypertensive patients in 18 Oxfordshire general practices using the VAMP computer system.
- Absolute cardiovascular event risk was measured using individual risk factor profiles.
- Multiple logistic regression analysis identified factors associated with uncontrolled hypertension.
Main Results:
- 40.9% of hypertensive patients had a 10-year absolute cardiovascular risk exceeding 20%.
- Higher blood pressure readings correlated with higher absolute risk, but not always.
- Independent factors for uncontrolled hypertension included age, sex, history of stroke/ischemic heart disease/transient ischemic attack, BMI > 30, diabetes, and smoking.
Conclusions:
- Absolute risk assessment optimizes the risk-benefit ratio in treated hypertensive patients.
- Individual hypertension management requires multifactorial assessment.
- Relying solely on blood pressure readings is insufficient for reducing cardiovascular disease absolute risk.
Background:
When managing hypertension, the assessment of the absolute risk of a cardiovascular' event is now advocated as the most accurate way in which the risks and benefits of anti-hypertensive therapy should be judged. Most studies that have examined control of hypertension have relied solely on the blood pressure level attained after treatment, with no measurement of the likely absolute risk in individual patients.
Aim:
To assess control of hypertension by quantifying the 10-year absolute risk of cardiovascular disease in patients treated by their general practitioners, and to assess which risk factors are associated with uncontrolled hypertension in this group of patients.
Method:
A cross-sectional study was made of patients on drug treatment for hypertension in 18 Oxfordshire general practices subscribing to the VAMP (value-added medical products) computer system. The absolute risk of suffering a cardiovascular event in the following 10 years was measured according to each individual's risk factor profile. Factors associated with uncontrolled hypertension were ascertained using multiple logistic regression analysis.
Results:
Overall, 40.9% (37.6% to 44.1%) of the hypertensive population had an absolute risk exceeding 20% of having a cardiovascular event in the following 10 years. The distribution of risk factors varies throughout the population. A higher blood pressure reading was strongly associated with an increased likelihood of high absolute risk, but high blood pressure readings in individual patients did not necessarily equate to a high absolute risk. The factors independently associated with uncontrolled hypertension were age, sex, past history of stroke, ischaemic heart disease and transient ischaemic attack, a body mass index greater than 30, diabetes, and current smoking.
Conclusions:
Absolute risk assessment maximizes the risk-benefit ratio in treated hypertensive patients. Individual control and management requires multifactorial assessment and management. Treatment of hypertension according to blood pressure reading alone is not a reliable way of reducing the absolute risk of cardiovascular disease.