Intended for healthcare professionals

Clinical Review Evidence based management of hypertension

Using cardiovascular risk profiles to individualise hypertensive treatment

BMJ 2001; 322 doi: (Published 12 May 2001) Cite this as: BMJ 2001;322:1164

This article has a correction. Please see:

  1. Michael Pignone (, assistant professor of medicinea,
  2. Cynthia D Mulrow, professor of medicineb
  1. a Division of General Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA,
  2. b Division of General Internal Medicine, University of Texas at San Antonio, San Antonio, TX 78249, USA
  1. Correspondence to: M Pignone

    This is the fourth in a series of five articles

    Individual risks must be assessed in order to for the best decision to be made as to which patients to treat and how. Assessment identifies important cardiovascular risk factors that may warrant treatment and helps to establish the absolute benefits that patients can expect from particular treatments. The benefits of treating hypertensive patients also vary, depending on each patient's competing risks of dying from other than cardiovascular causes. For example, patients with multiple serious conditions, such as end stage Alzheimer's disease, obstructive lung disease, frequent falls, gout, and urinary incontinence, have high competing risks that may minimise or negate the benefits of treating their hypertension.

    Summary points

    Several treatment options reduce risk of cardiovascular disease and improve outcomes in patients with hypertension

    Providers should consider the expected benefits and potential adverse effects of different treatment options and discuss them with patients

    The use of decision tools may help decision making about options for reducing cardiovascular risk

    Factors useful in helping patients prioritise their treatments

    Establishing treatment priorities for patients with multiple cardiovascular risk factors and multiple conditions is difficult. Factors such as those given in the box deserve consideration. Knowing and weighing up multiple risk factors, conditions, and treatments is difficult. Explaining them to patients is daunting and time consuming. Some patients prefer to be told what to do rather than to have to take in the diverse, complicated information necessary to make their …

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