Is coronary risk an accurate surrogate for cardiovascular risk for treatment decisions in mild hypertension? A population validation.
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.
Wallis
E J
EJ
Clinical Pharmacology and Therapeutics, Royal Hallamshire Hospital, Sheffield, UK.
Ramsay
L E
LE
Haq
I U
IU
Ghahramani
P
P
Jackson
P R
PR
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