RECONCILING DIFFERENT MEASURES OF RISK IN THE TREATMENT OF HYPERTENSION - A COMMUNITY-BASED STUDY

Background: There is disagreement as to how cardiovascular risk in hyp ertensive patients should be measured. In particular, whether absolute risk measurement alone is a realistic index on which to base treatmen t goals. Method: A cross-sectional study on 895 treated hypertensive p atients in 18 general practices in the UK. Reporting on the distributi on and magnitude of age-specific absolute risk. The percentage of indi viduals with controlled hypertension whose absolute risk exceeds their age/sex absolute risk standard and the percentage of individuals with uncontrolled hypertension whose risk is less than their age/sex absol ute risk standard. Results: Overall, 62.8% (95% Cl 59.6-66%) individua ls had an absolute risk that exceeded 20% over 10 years. The magnitude of absolute risk was considerable (range 3.5-87.8%) and increasing ab solute risk was significantly associated with age. Of those individual s with controlled hypertension 50.5% (95% Cl 45.1-55.8%) had an absolu te risk which exceeded their age/sex absolute risk standard. Conversel y, 30.4% (95% Cl 26.6-34.2%) of those with uncontrolled hypertension h ad an absolute risk that was less than their age/sex absolute risk sta ndard. Conclusions: The distribution and magnitude of absolute risk is significantly associated with age. Appreciation of such a relationshi p is needed when setting realistic treatment goals according to an abs olute risk standard, particularly in the elderly. In addition, the use an age/sex absolute risk standard is likely to further modify treatme nt goals in individuals at high and low absolute risk of cardiovascula r disease.