The estimation of cardiovascular risk of hypertensive subjects does not modify the management of hypertension

Objectives : To compare antihypertensive therapeutic strategies and efficac y whether the physicians were aware or not of the calculated cardiovascular risk at 10 years obtained from the Framingham equation. It was also possib le to evaluate the concordance of the general physicians estimation of the cardiovascular risk with the calculated percentage. Methods: The participation of 953 general physicians to the study allowed t o achieve an estimation of the absolute cardiovascular risk for 1 243 hyper tensives. Patients were randomised in 2 groups according to the knowledge o r not by the physicians of the calculated risk. The therapeutic strategy in cluded a monotherapy (Fosinopril 20 mg/days) for a follow up of 8 weeks, wi th the possibility to increase the treatment after 4 weeks (Fosinopril + hy drochlorotiazide). To be included, patients had to be more than 18 and less than 75 years, and a blood pressure above 140/90 mmHg. Estimated and calcu lated cardiovascular risk at 10 years, were classified according to the 199 9 WHO-ISM guidelines: low risk <15%, medium risk 15-20%, high risk 20-30%, very high risk >30%. Results: In this population, aged 60+/-10 years, with 54% of men, the conco rdance between estimated risk and calculated risk was of 35%. This concorda nce was better for the "low risk" and "very high risk", but remains inferio r to 50%. The determinants of concordance were: gender (male), smoking and a low MDL cholesterol. After 8 weeks of treatment, no difference was observ ed between the 2 groups concerning final blood pressure level, percentage o f normalised patients and number of patients with bitherapy. Conclusions: General physicians estimation of cardiovascular risk at 10 yea rs of hypertensive subjects has a bad concordance with the calculated risk according to Framingham equation. The results of this study indicate that t he estimation of cardiovascular risk of hypertensive subjects does not modi fy the management of hypertension.