Coronary risk versus cardiovascular risk for treatment decisions in mild hypertension.
BACKGROUND
British guidelines recommend treatment for mild hypertension at a cardiovascular (CVD) risk threshold of 20% over 10 years. However, treatment is targeted at the equivalent coronary (CHD) risk of 15% over 10 years. We examined the relationship between CHD and CVD risk in men and women with mild hypertension and assessed the accuracy of using a 10-year CHD risk threshold of 15% to identify patients at a 10-year CVD risk > or = 20%.


METHODS
Cross-sectional survey of England in 1998.


METHODS
We identified 5588 subjects aged 35-74 years free of cardiovascular disease with complete data for risk assessment. Of these, 1364 (24.4%) had mild hypertension (systolic pressure 140-159 mmHg or diastolic pressure 90-99 mmHg). The Framingham functions were used to estimate CHD and CVD event risk for each individual.


RESULTS
At a 10-year CHD risk of 15%, the corresponding 10-year CVD risk for men and women, respectively was 20% and 21% in those aged < 55 years, and 24% and 25% in those aged > or = 55 years. Using a 10-year CHD risk threshold of 15% to identify patients at a 10-year CVD risk > or = 20% had high specificity (>96%) in all four groups. For men and women respectively, the sensitivity was 73% (62-84%) and 62% (35-88%) in younger subjects, and 89% (85-93%) and 47% (38-56%) in older subjects.


CONCLUSIONS
Using a 10-year CHD risk of 15% to target patients at a 10-year CVD risk > or = 20% was reasonably accurate for men but missed about 50% of women eligible for antihypertensive treatment.
Yeo
Wilfred W
WW
Clinical Pharmacology & Therapeutics, Division of CLinical Sciences (S), University of Sheffield, UK. w.w.yeo@sheffield.ac.uk
Yeo
Karen Rowland
KR
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D016001:Confidence Intervals; D003327:Coronary Disease / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012044:Regression Analysis; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology