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Reconciling different measures of risk in the treatment of hypertension: a community-based study
1Division of Primary Health Care, University of Bristol, UK.
Insights
Assessing cardiovascular risk in hypertensive patients requires considering age-specific absolute risk. This study highlights the need for tailored treatment goals, especially for the elderly, using age/sex risk standards.
Area of Science:
- Cardiology
- Public Health
- Geriatrics
Background:
- Disagreement exists on measuring cardiovascular risk in hypertensive patients.
- The adequacy of absolute risk alone for setting treatment goals is debated.
Purpose of the Study:
- To investigate the distribution and magnitude of age-specific absolute cardiovascular risk in treated hypertensive patients.
- To evaluate the utility of age/sex absolute risk standards in guiding treatment goals.
Main Methods:
- Cross-sectional study of 895 treated hypertensive patients across 18 UK general practices.
- Analysis of absolute cardiovascular risk distribution and its association with age.
- Comparison of individual absolute risk with age/sex-specific risk standards.
Main Results:
- Over 60% of patients had a 10-year absolute cardiovascular risk exceeding 20%.
- Absolute risk significantly increased with age, ranging from 3.5% to 87.8%.
- Half of patients with controlled hypertension exceeded their age/sex risk standard, while a third with uncontrolled hypertension fell below it.
Conclusions:
- Age is a significant factor in the distribution and magnitude of absolute cardiovascular risk.
- Age-specific absolute risk standards are crucial for setting realistic treatment goals, particularly in the elderly.
- Utilizing age/sex absolute risk standards can refine treatment strategies for individuals across the risk spectrum.
Background:
There is disagreement as to how cardiovascular risk in hypertensive patients should be measured. In particular, whether absolute risk measurement alone is a realistic index on which to base treatment goals.
Method:
A cross-sectional study on 895 treated hypertensive patients in 18 general practices in the UK. Reporting on the distribution and magnitude of age-specific absolute risk. The percentage of individuals with controlled hypertension whose absolute risk exceeds their age/sex absolute risk standard and the percentage of individuals with uncontrolled hypertension whose risk is less than their age/sex absolute risk standard.
Results:
Overall, 62.8% (95% CI 59.6-66%) individuals had an absolute risk that exceeded 20% over 10 years. The magnitude of absolute risk was considerable (range 3.5-87.8%) and increasing absolute risk was significantly associated with age. Of those individuals with controlled hypertension 50.5% (95% CI 45.1-55.8%) had an absolute risk which exceeded their age/sex absolute risk standard. Conversely, 30.4% (95% CI 26.6-34.2%) of those with uncontrolled hypertension had an absolute risk that was less than their age/sex absolute risk standard.
Conclusions:
The distribution and magnitude of absolute risk is significantly associated with age. Appreciation of such a relationship is needed when setting realistic treatment goals according to an absolute risk standard, particularly in the elderly. In addition, the use an age/sex absolute risk standard is likely to further modify treatment goals in individuals at high and low absolute risk of cardiovascular disease.