Cardiovascular risk factors and their effects on the decision to treat hypertension: evidence based review

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ education articles:

From

Limit by

The BMJ iPad app brings you the best of print and online, including live links to the latest news, blogs, video, and podcasts. Get the BMJ iPad app.
You can use bmj.com to help you with your continuing medical education. Find out about CME/CPD credits for BMJ articles
Keep up to date with cardiology: Access the latest cardiovascular medicine resources from across BMJ Group.
Countdown to London 2012: BMJ Group's Olympics portal highlights latest Olympics and sports medicine-themed research, comment and learning

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Raj Padwal, clinical research fellowa,
Sharon E Straus, assistant professorb,
Finlay A McAlister (Finlay.McAlister@ualberta.ca), assistant professora

^a Division of General Internal Medicine, University of Alberta, Edmonton, AL, Canada T6G 2R7,
^b Division of General Internal Medicine, Mount Sinai Hospital, Toronto, ON, Canada M5G 1XS

Correspondence to: F A McAlister

This is the second in a series of five articles

Blood pressure, like any physiological variable, is normally distributed in the population. Not surprisingly, expert bodies disagree substantially on the definition of hypertension—of the 27 national hypertension societies represented at the 17th world conference of the Hypertension League Council held in Montreal in 1997, 14 use 140/90 mm Hg to diagnose hypertension and 13 use 160/95 mm Hg.1

Summary points

There is a continuous, strong, and graded relation between blood pressure and cardiovascular disease, but no clear threshold value separates hypertensive patients who will experience future cardiovascular events from those who will not

Risk of cardiovascular disease depends on blood pressure, coexistent risk factors, and whether there is hypertensive damage to target organs

Numerous factors definitely increase cardiovascular risk, including age, male sex, family history, raised cholesterol, smoking, diabetes mellitus, obesity, sedentary lifestyle, and left ventricular hypertrophy

Models can be used to predict an individual's risk of cardiovascular disease to define the expected benefits and harms of treatment

Hypertension and cardiovascular risk

Relative risk

Most population based studies confirm that hypertension increases an individual's risk of various cardiovascular consequences approximately two to three times (figure). Large population based cohort studies consistently show continuous, strong, and graded relations between blood pressure (particularly systolic pressure) and the subsequent occurrence of various atherosclerotic events. 2 3 The sizes of the relative risks reported in each study depend on the duration of follow up and the definition of hypertension in use.4 These relative risks are consistent across all settings5 and for all patient subgroups, including those with and without known atherosclerotic disease.6

Risk of atherosclerotic disease in people with hypertension

Multiple high quality long term cohort studies and randomised clinical trials have shown that the risks from raised blood pressure can be partially reversed. 6 7 Two important …