Document Detail

Is coronary risk an accurate surrogate for cardiovascular risk for treatment decisions in mild hypertension? A population validation.
MedLine Citation:
PMID:  11330871     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To examine the relationship between coronary (CHD) and cardiovascular (CVD) risk in patients with uncomplicated mild hypertension and to determine the accuracy of using CHD risk > or = 15% over 10 years to identify for antihypertensive treatment those patients with CVD risk > or = 20% over 10 years as advised in recent British guidelines. DESIGN: Comparison of decisions made using CHD risk > or = 15% over 10 years calculated by the Framingham risk function and estimated using a simple table with CVD risk > or = 20% over 10 years. SETTING: British population. SUBJECTS: People aged 35-64 years with uncomplicated mild systolic hypertension (SBP 140-159 mmHg, n = 624) from the 1995 Scottish Health Survey. MAIN OUTCOME MEASURES: Relationship between CHD and CVD risk. Sensitivity, specificity, positive and negative predictive values (PPV and NPV). RESULTS: CHD risk 15% over 10 years was equivalent to CVD risk 21% over 10 years. Exact CHD risk > or = 15% over 10 years had sensitivity 79%, specificity 98%, PPV 94% and NPV 93% in detecting CVD risk > or = 20% over 10 years. Use of the table to estimate CHD risk > or = 15% over 10 years gave sensitivity 88%, specificity 90%, PPV 76% and NPV 95%. CONCLUSION: CHD risk appears acceptably accurate for targeting treatment in mild hypertension. The risk assessment table, which slightly overestimates CHD risk, was more sensitive in identifying patients with CVD risk > or = 20% over 10 years and may be preferable to using exact CHD risk. European guidelines which suggest targeting treatment for mild hypertension at CHD risk > or = 20% over 10 years are over-conservative compared with British guidelines.
E J Wallis; L E Ramsay; I U Haq; P Ghahramani; P R Jackson
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of hypertension     Volume:  19     ISSN:  0263-6352     ISO Abbreviation:  J. Hypertens.     Publication Date:  2001 Apr 
Date Detail:
Created Date:  2001-05-01     Completed Date:  2001-08-16     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8306882     Medline TA:  J Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  691-6     Citation Subset:  IM    
Clinical Pharmacology and Therapeutics, Royal Hallamshire Hospital, Sheffield, UK.
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MeSH Terms
Cardiovascular Diseases / etiology*
Coronary Disease / etiology*
Differential Threshold
Hypertension / complications*,  therapy*
Middle Aged
Risk Factors
Sensitivity and Specificity

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