7893
document
1999 WHO/ISH Guidelines applied to a 1999 MONICA sample from northern Sweden . BACKGROUND Treating hypertension with drugs is so far the most cost-effective way to reduce this important risk factor for cardiovascular disease ( CVD ) . It is , however , important to determine absolute risk , and thereby estimate indication for drug treatment , in order to maintain a cost-effective drug treatment . WHO/ISH Hypertension Guidelines from 1999 propose a risk stratification for estimating absolute risk for CVD based on blood pressure and additional risk factors , target organ damage ( TOD ) and CVD . OBJECTIVES We studied the consequences of applying the recent WHO/ISH risk stratification scheme to a MONICA sample of 6000 subjects from a geographically defined population in northern Sweden , regarding indications for treatment , target blood pressure and risk distribution . METHODS We have risk-classified each of these patients using a computer program , according to the WHO/ISH scheme . Data on TOD were not available . RESULTS In all , 917 ( 15 % ) had drug-treated hypertension . Three-quarters ( n = 737 ) were inadequately treated , with blood pressure levels at or above 140 or 90 mmHg . 1773 ( 30 % of 5997 ) untreated subjects had a blood pressure of 140/90 or above ; 16 % in the low- , 62 % in the medium- , 8 % in the high- , and 14 % in the very-high-risk group . The corresponding risk-group pattern for the inadequately treated hypertensives ( n = 737 ) was 5.5 , 48.3 , 11.1 and 35.2 % , respectively . If we shifted the target blood pressure from below 140/90 to below 130/85 for drug-treated subjects under 60 ( n = 278 ) the number of inadequately treated subjects increased by 34 ( 12.2 % of 278 ) ; 14 in the low-risk group , 15 in the medium-risk group , and only five in the high- or very-high-risk groups . CONCLUSIONS Only one-fifth of the drug-treated hypertensives were well controlled . Moreover , the incidence of newly detected blood pressure elevation was high . The majority of younger subjects with high blood pressure had low risk , but in those aged 45-54 this had already risen to a medium risk . Changing the target blood pressure to below 130/85 , for subjects aged below 60 , as recommended by WHO/ISH , affects predominantly low- and medium-risk groups .
7894
Intervention_Physical
WHO/ISH risk stratification scheme
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Intervention_Other
computer program
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Outcome_Physical
blood pressure levels
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Outcome_Other
number of inadequately treated subjects
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Outcome_Physical
newly detected blood pressure elevation
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Participant_Condition
drug-treated hypertension
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Participant_Age
aged 45-54
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Participant_Age
subjects aged below 60