An epidemiological perspective in hypertension problem solving.

Hypertension predisposes to all the major atherosclerotic cardiovascular disease outcomes, with coronary heart disease (CHD) the most common and lethal sequela. Hypertension is only one of many risk factors for CHD and is variably hazardous, depending on the number and severity of co-existent, metabolically linked risk factors. Importantly, about half the CHD events occur in hypertensive patients in the upper quartile of multivariate risk. An epidemiologist can recognize differences in hypertensive candidates for cardiovascular disease based on their cardiovascular risk profile rather than relying solely on the character of the blood pressure elevation. Once a composite risk profile for hypertensive patients has been established, at-risk individuals can be more readily identified, allowing treatment to be more appropriately targeted to improve the multivariate cardiovascular risk profile whilst reducing the blood pressure. Such an approach provides maximum benefit and cost effectiveness.