[The estimation of cardiovascular risk in hypertensive patients is not modified by management of the hypertension].
OBJECTIVE
To compare antihypertensive therapeutic strategies and efficacy whether the physicians were aware or not of the calculated cardiovascular risk at 10 years obtained from the Framingham equation. It was also possible to evaluate the concordance of the general physicians estimation of the cardiovascular risk with the calculated percentage.


METHODS
The participation of 953 general physicians to the study allowed to achieve an estimation of the absolute cardiovascular risk for 1,243 hypertensives. Patients were randomised in 2 groups according to the knowledge or not by the physicians of the calculated risk. The therapeutic strategy included a monotherapy (Fosinopril 20 mg/days) for a follow up of 8 weeks, with the possibility to increase the treatment after 4 weeks (Fosinopril + hydrochlorotiazide). To be included, patients had to be more than 18 and less than 75 years, and a blood pressure above 140/90 mmHg. Estimated and calculated cardiovascular risk at 10 years, were classified according to the 1999 WHO-ISH guidelines: low risk < 15%, medium risk 15-20%, high risk 20-30%, very high risk > 30%.


RESULTS
In this population, aged 60 +/- 10 years, with 54% of men, the concordance between estimated risk and calculated risk was of 35%. This concordance was better for the "low risk" and "very high risk", but remains inferior to 50%. The determinants of concordance were: gender (male), smoking and a low HDL cholesterol. After 8 weeks of treatment, no difference was observed between the 2 groups concerning final blood pressure level, percentage of normalised patients and number of patients with bi-therapy.


CONCLUSIONS
General physicians estimation of cardiovascular risk at 10 years of hypertensive subjects has a bad concordance with the calculated risk according to Framingham equation. The results of this study indicate that the estimation of cardiovascular risk of hypertensive subjects does not modify the management of hypertension.
Hanon
O
O
Service de médecine interne, hôpital Broussais, Paris.
Franconi
G
G
Mourad
J J
JJ
Baleydier
A
A
Croce
I
I
Girerd
X
X
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D008076:Cholesterol, HDL / Q000097:blood; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D017328:Fosinopril / Q000008:administration & dosage / Q000627:therapeutic use; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D008076:Cholesterol, HDL; D004338:Drug Combinations; D006852:Hydrochlorothiazide; D017328:Fosinopril