Fahey T P, Peters T J
Department of Social Medicine, University of Bristol.
Br J Gen Pract. 1996 Nov;46(412):655-9.
When managing hypertension, the assessment of the absolute risk of a cardiovascular' event is now advocated as the most accurate way in which the risks and benefits of anti-hypertensive therapy should be judged. Most studies that have examined control of hypertension have relied solely on the blood pressure level attained after treatment, with no measurement of the likely absolute risk in individual patients.
To assess control of hypertension by quantifying the 10-year absolute risk of cardiovascular disease in patients treated by their general practitioners, and to assess which risk factors are associated with uncontrolled hypertension in this group of patients.
A cross-sectional study was made of patients on drug treatment for hypertension in 18 Oxfordshire general practices subscribing to the VAMP (value-added medical products) computer system. The absolute risk of suffering a cardiovascular event in the following 10 years was measured according to each individual's risk factor profile. Factors associated with uncontrolled hypertension were ascertained using multiple logistic regression analysis.
Overall, 40.9% (37.6% to 44.1%) of the hypertensive population had an absolute risk exceeding 20% of having a cardiovascular event in the following 10 years. The distribution of risk factors varies throughout the population. A higher blood pressure reading was strongly associated with an increased likelihood of high absolute risk, but high blood pressure readings in individual patients did not necessarily equate to a high absolute risk. The factors independently associated with uncontrolled hypertension were age, sex, past history of stroke, ischaemic heart disease and transient ischaemic attack, a body mass index greater than 30, diabetes, and current smoking.
Absolute risk assessment maximizes the risk-benefit ratio in treated hypertensive patients. Individual control and management requires multifactorial assessment and management. Treatment of hypertension according to blood pressure reading alone is not a reliable way of reducing the absolute risk of cardiovascular disease.
在管理高血压时，目前提倡评估心血管事件的绝对风险，认为这是判断抗高血压治疗风险和益处的最准确方法。大多数研究高血压控制情况的研究仅依赖治疗后达到的血压水平，而未测量个体患者可能的绝对风险。
通过量化全科医生治疗的患者发生心血管疾病的10年绝对风险来评估高血压控制情况，并评估哪些风险因素与该组患者未控制的高血压相关。
对18个使用VAMP（增值医疗产品）计算机系统的牛津郡全科诊所中接受高血压药物治疗的患者进行横断面研究。根据每个人的风险因素概况测量未来10年发生心血管事件的绝对风险。使用多元逻辑回归分析确定与未控制的高血压相关的因素。
总体而言，40.9%（37.6%至44.1%）的高血压患者在未来10年发生心血管事件的绝对风险超过20%。风险因素在整个人口中的分布各不相同。较高的血压读数与高绝对风险的可能性增加密切相关，但个体患者的高血压读数不一定等同于高绝对风险。与未控制的高血压独立相关的因素包括年龄、性别、中风病史、缺血性心脏病和短暂性脑缺血发作、体重指数大于30、糖尿病和当前吸烟。
绝对风险评估可使治疗的高血压患者的风险效益比最大化。个体控制和管理需要多因素评估和管理。仅根据血压读数治疗高血压不是降低心血管疾病绝对风险的可靠方法。
