title: Is coronary risk an accurate surrogate for cardiovascular risk for treatment decisions in mild hypertension? A population validation.
abstract: OBJECTIVE
  To examine the relationship between coronary (CHD) and cardiovascular (CVD) risk in patients with uncomplicated mild hypertension and to determine the accuracy of using CHD risk > or = 15% over 10 years to identify for antihypertensive treatment those patients with CVD risk > or = 20% over 10 years as advised in recent British guidelines.
  
  
  METHODS
  Comparison of decisions made using CHD risk > or = 15% over 10 years calculated by the Framingham risk function and estimated using a simple table with CVD risk > or = 20% over 10 years.
  
  
  METHODS
  British population.
  
  
  METHODS
  People aged 35-64 years with uncomplicated mild systolic hypertension (SBP 140-159 mmHg, n = 624) from the 1995 Scottish Health Survey.
  
  
  METHODS
  Relationship between CHD and CVD risk. Sensitivity, specificity, positive and negative predictive values (PPV and NPV).
  
  
  RESULTS
  CHD risk 15% over 10 years was equivalent to CVD risk 21% over 10 years. Exact CHD risk > or = 15% over 10 years had sensitivity 79%, specificity 98%, PPV 94% and NPV 93% in detecting CVD risk > or = 20% over 10 years. Use of the table to estimate CHD risk > or = 15% over 10 years gave sensitivity 88%, specificity 90%, PPV 76% and NPV 95%.
  
  
  CONCLUSIONS
  CHD risk appears acceptably accurate for targeting treatment in mild hypertension. The risk assessment table, which slightly overestimates CHD risk, was more sensitive in identifying patients with CVD risk > or = 20% over 10 years and may be preferable to using exact CHD risk. European guidelines which suggest targeting treatment for mild hypertension at CHD risk > or = 20% over 10 years are over-conservative compared with British guidelines.
authors.affiliation: Clinical Pharmacology and Therapeutics, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: E J
authors.initials: EJ
authors.lastname: Wallis
authors.forename: L E
authors.initials: LE
authors.lastname: Ramsay
authors.forename: I U
authors.initials: IU
authors.lastname: Haq
authors.forename: P
authors.initials: P
authors.lastname: Ghahramani
authors.forename: P R
authors.initials: PR
authors.lastname: Jackson
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology*; D003327:Coronary Disease / Q000209:etiology*; D004056:Differential Threshold; D005544:Forecasting; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000628:therapy*; D008875:Middle Aged; D012307:Risk Factors; D012680:Sensitivity and Specificity