Implication of recent trials with b-hydroxy-b-methylglutaryl coenzyme A reductase inhibitors for hypertension management

Background There is broad agreement that statin treatment should be targete d at absolute coronary heart disease (CHD) risk but no consensus on the lev el of risk to target. We have examined the implications of adopting three d ifferent treatment policies for the management of hypertensive patients in the UK using data from treated hypertensives aged 35-69 years included in t he Health Survey for England (1993). Methods We calculated the proportion of hypertensive patients with existing atherosclerotic cardiovascular disease requiring statin treatment for seco ndary prevention of CHD. For those without atherosclerotic cardiovascular d isease (primary prevention), we estimated CHD risk from the Framingham equa tion and examined the proportion with CHD risk exceeding thresholds of 4.5, 3 and 1.5% per year. Results Twenty-one percent of treated hypertensives would require statin tr eatment for secondary prevention of CHD. When the CHD event threshold for s tatin treatment was set at greater than or equal to 4.5% per year [equivale nt to a number needed to treat (NNT) in 5 years of 13] a further 0.6% of hy pertensive patients were identified for treatment; at a threshold of 3.0% p er year (NNT = 20) 5.5% of patients were identified for primary prevention; and at a threshold of 1.5% per year (NNT = 40) 28.5% of patients were iden tified for primary prevention. Conclusions Those needing secondary prevention are first priority for stati ns and 21% of hypertensive patients will require treatment Formulation of g uidelines for primary prevention should take into account the NNT; the prop ortion of patients targeted for treatment; the cost-effectiveness and the t otal cost of treatment, Current British guidance will entail treating an ad ditional 5.5% of hypertensive patients for primary prevention and therefore 27% of hypertensive patients. (C) Lippincott Williams & Wilkins.