Abstract
BACKGROUND: The National Service Framework for coronary heart disease requires primary care teams to identify patients who are at high risk of cardiovascular events and treat those with high blood pressure. However, there are no data on how many must be assessed, how much cardiovascular disease can be prevented or which patients are most likely to benefit. AIM: To estimate the potential number of patients who are eligible for blood pressure assessment, the number of preventable cardiovascular disease events and the relative efficiency of the strategy in different age groups. DESIGN OF STUDY: Modelling exercise. SETTING: Hypothetical population of 100,000. METHOD: The age-sex specific prevalence of cardiovascular risk factors and of current anti-hypertensive treatment were obtained from published sources and combined with published estimates of the effectiveness of anti-hypertensive treatment. From these data were calculated numbers of persons eligible for assessment and treatment, and numbers of preventable cardiovascular events. RESULTS: There were 79,607 persons eligible for assessment and 5888 eligible for treatment. Treatment could prevent between 101 and 139 cardiovascular events annually. There were 11,571 persons aged over 65 years and eligible for assessment and 4655 eligible for treatment. Treatment could prevent 85 to 117 cardiovascular events annually. No cardiovascular events are prevented in persons aged under 45 years. CONCLUSION: Confining assessment to the 16% who are aged over 65 years prevents 85% of the population's avoidable cardiovascular disease. Primary care teams should assess and treat persons aged over 65 years before assessing younger patients. No health benefit results from assessing persons aged under 45 years.
Full Text
The Full Text of this article is available as a PDF (65.6 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee. J Hypertens. 1999 Feb;17(2):151–183. [PubMed] [Google Scholar]
- Anderson K. M., Wilson P. W., Odell P. M., Kannel W. B. An updated coronary risk profile. A statement for health professionals. Circulation. 1991 Jan;83(1):356–362. doi: 10.1161/01.cir.83.1.356. [DOI] [PubMed] [Google Scholar]
- Baker S., Priest P., Jackson R. Using thresholds based on risk of cardiovascular disease to target treatment for hypertension: modelling events averted and number treated. BMJ. 2000 Mar 11;320(7236):680–685. doi: 10.1136/bmj.320.7236.680. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Collins R., Peto R., MacMahon S., Hebert P., Fiebach N. H., Eberlein K. A., Godwin J., Qizilbash N., Taylor J. O., Hennekens C. H. Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet. 1990 Apr 7;335(8693):827–838. doi: 10.1016/0140-6736(90)90944-z. [DOI] [PubMed] [Google Scholar]
- Jackson R., Barham P., Bills J., Birch T., McLennan L., MacMahon S., Maling T. Management of raised blood pressure in New Zealand: a discussion document. BMJ. 1993 Jul 10;307(6896):107–110. doi: 10.1136/bmj.307.6896.107. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jackson R., Feder G. Guidelines for clinical guidelines. BMJ. 1998 Aug 15;317(7156):427–428. doi: 10.1136/bmj.317.7156.427. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Materson B. J., Reda D. J., Cushman W. C., Massie B. M., Freis E. D., Kochar M. S., Hamburger R. J., Fye C., Lakshman R., Gottdiener J. Single-drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. N Engl J Med. 1993 Apr 1;328(13):914–921. doi: 10.1056/NEJM199304013281303. [DOI] [PubMed] [Google Scholar]
- Philipp T., Anlauf M., Distler A., Holzgreve H., Michaelis J., Wellek S. Randomised, double blind, multicentre comparison of hydrochlorothiazide, atenolol, nitrendipine, and enalapril in antihypertensive treatment: results of the HANE study. HANE Trial Research Group. BMJ. 1997 Jul 19;315(7101):154–159. doi: 10.1136/bmj.315.7101.154. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Psaty B. M., Furberg C. D. British guidelines on managing hypertension. Provide evidence, progress, and an occasional missed opportunity. BMJ. 1999 Sep 4;319(7210):589–590. doi: 10.1136/bmj.319.7210.589. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Unwin N., Thomson R., O'Byrne A. M., Laker M., Armstrong H. Implications of applying widely accepted cholesterol screening and management guidelines to a British adult population: cross sectional study of cardiovascular disease and risk factors. BMJ. 1998 Oct 24;317(7166):1125–1130. doi: 10.1136/bmj.317.7166.1125. [DOI] [PMC free article] [PubMed] [Google Scholar]