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Clinical Review Evidence based management of hypertension

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

BMJ 2001; 322 doi: (Published 21 April 2001) Cite this as: BMJ 2001;322:977
  1. Raj Padwal, clinical research fellowa,
  2. Sharon E Straus, assistant professorb,
  3. Finlay A McAlister (, assistant professora
  1. a Division of General Internal Medicine, University of Alberta, Edmonton, AL, Canada T6G 2R7,
  2. b Division of General Internal Medicine, Mount Sinai Hospital, Toronto, ON, Canada M5G 1XS
  1. 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 …

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