At What Level Of Cvd Risk Is Treatment Justified

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British guidelines recommend treatment for those with CHD risk > 15% over 10 years,4 5 and this is equivalent to the CVD risk threshold of > 20% over 10 years recommended in the New Zealand guidelines.3 Around 25% of patients with uncomplicated mild hypertension have CHD risk > 15% over 10 years.15 The relative risk reduction by treatment is 25%, and the absolute risk reduction with treatment at this level of risk is 5% over 10 years. This equates to a five year NNT of 40 to prevent one major cardiovascular complication. The WHO-ISH and JNC-VI guidelines advocate risk assessment but are not explicit on the level of risk to be treated. However, their risk assessment methods lead to treatment of very low risk patients and to a much larger NNT. The minimum acceptable level of absolute benefit from antihypertensive treatment can be debated but really needs to be studied. Antihypertensive treatment targeted at the level of risk recommended in British guidelines is undoubtedly safe, meaning that benefit clearly outweighs any serious harm. Cost effectiveness is also well within generally accepted limits. However, the level of absolute benefit at which treatment becomes worthwhile is extremely difficult to assess. The chance of a cardiovascular complication being prevented, and the value of this, must be weighed against possible harm, discomfort, and inconvenience of long term tablet taking. Doctors can debate this endlessly, but the correct answers can only come from formal study of the choices of fully informed patients or potential patients. Little research has been done to determine what benefit (or NNT) is generally acceptable to patients. One study suggested that most would opt to take preventative treatment for an NNT of 40, while another suggested they would not. It is doubtful whether fully informed people would choose to take treatment for the extremely low chance of benefit (or high NNT) that follows from the WHO-ISH or JNC-VI guidelines.

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Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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