Beyond hypertension toward guidelines for cardiovascular risk reduction.
BACKGROUND
Most current clinical guidelines focus primarily on the management of individual cardiovascular risk factors, such as high blood pressure (BP), hypercholesterolemia, or diabetes. A more appropriate clinical approach to reducing cardiovascular disease risk would be based on a comprehensive evaluation of risk profile, and accurate stratification of global (absolute) risk in individual patients. We propose that global risk should be used as the main determinant of whom to treat, how to treat, and how much to treat.


METHODS
In this article we use a series of case studies to demonstrate the implications of replacing the traditional "single risk factor-based" approach to managing hypertension by one based on global risk assessment. In some situations patients with mildly elevated BP levels would not be recommended for antihypertensive drug treatment whereas others with lower BP would be treated, depending upon the entire risk profile.


CONCLUSIONS
We propose to replace the single risk factor-based approach with the assessment of global cardiovascular risk, both in the clinical management of individual patients and in guidelines.
Volpe
Massimo
M
Department of Cardiology, II Faculty of Medicine, University of Rome La Sapienza Rome, Rome, Italy. volpema@uniroma1.it
Alderman
Michael H
MH
Furberg
Curt D
CD
Jackson
Rodney
R
Kostis
John B
JB
Laragh
John H
JH
Psaty
Bruce M
BM
Ruilope
Luis M
LM
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D016022:Case-Control Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors
D000959:Antihypertensive Agents