title: Beyond hypertension toward guidelines for cardiovascular risk reduction.
abstract: 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.
authors.affiliation: Department of Cardiology, II Faculty of Medicine, University of Rome La Sapienza Rome, Rome, Italy. volpema@uniroma1.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Volpe
authors.forename: Michael H
authors.initials: MH
authors.lastname: Alderman
authors.forename: Curt D
authors.initials: CD
authors.lastname: Furberg
authors.forename: Rodney
authors.initials: R
authors.lastname: Jackson
authors.forename: John B
authors.initials: JB
authors.lastname: Kostis
authors.forename: John H
authors.initials: JH
authors.lastname: Laragh
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.forename: Luis M
authors.initials: LM
authors.lastname: Ruilope
mesh_terms: 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
chemical_list: D000959:Antihypertensive Agents