Reconciling different measures of risk in the treatment of hypertension: a community-based study.
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.


METHODS
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.
Fahey
T
T
Division of Primary Health Care, University of Bristol, UK.
Peters
T J
TJ
D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012306:Risk; D012307:Risk Factors; D012737:Sex Factors; D006113:United Kingdom