Meeting the National Service Framework for coronary heart disease: which patients have untreated high blood pressure?
BACKGROUND
The National Service Framework for coronary heart disease requires primary care teams to identify patients who are at high risk of cardiovascular events and treat those with high blood pressure. However, there are no data on how many must be assessed, how much cardiovascular disease can be prevented or which patients are most likely to benefit.


OBJECTIVE
To estimate the potential number of patients who are eligible for blood pressure assessment, the number of preventable cardiovascular disease events and the relative efficiency of the strategy in different age groups.


METHODS
Modelling exercise.


METHODS
Hypothetical population of 100,000.


METHODS
The age-sex specific prevalence of cardiovascular risk factors and of current anti-hypertensive treatment were obtained from published sources and combined with published estimates of the effectiveness of anti-hypertensive treatment. From these data were calculated numbers of persons eligible for assessment and treatment, and numbers of preventable cardiovascular events.


RESULTS
There were 79,607 persons eligible for assessment and 5888 eligible for treatment. Treatment could prevent between 101 and 139 cardiovascular events annually. There were 11,571 persons aged over 65 years and eligible for assessment and 4655 eligible for treatment. Treatment could prevent 85 to 117 cardiovascular events annually. No cardiovascular events are prevented in persons aged under 45 years.


CONCLUSIONS
Confining assessment to the 16% who are aged over 65 years prevents 85% of the population's avoidable cardiovascular disease. Primary care teams should assess and treat persons aged over 65 years before assessing younger patients. No health benefit results from assessing persons aged under 45 years.
Marshall
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University of Birmingham, Edgbaston, Birmingham B15 2TT. T.P.Marshall@bham.ac.uk
Rouse
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D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003327:Coronary Disease / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D008962:Models, Theoretical; D018579:Patient Selection; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012737:Sex Factors