Cardiovascular risk management of hypertension and

Authors: I van Dis J M Geleijnse W M M Verschuren D Kromhout

Publish Date: 2012/04/03

Volume: 20, Issue: 7-8, Pages: 320-325

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Abstract

About 30 years ago the first Dutch unifactorial guidelines on hypertension and hypercholesterolaemia were developed These guidelines have been revised several times often after publication of landmark studies on new generations of drugs In 1978 cutoff points for pharmacological treatment of hypertension were based on diastolic blood pressure values ≥115 mmHg and in 2000 they were lowered to 100 mmHg From 1997 onwards cutoff points for systolic blood pressure values 180 mmHg were introduced which became leading In 1987 cutoffs for hypercholesterolaemia of ≥8 mmol/l were set and from 2006 pharmacological treatment was based on a total/HDL cholesterol ratio 8 Around 2000 treatment decisions for hypertension and/or hypercholesterolaemia were no longer based on high levels of individual risk factors but on a multifactorial approach based on total risk of cardiovascular diseases CVD determined by a risk function In the 2006 multidisciplinary guideline on cardiovascular risk management the Framingham risk tables were replaced by European SCORE risk charts A cutoff point of 10 CVD mortality was set in the Netherlands In 2011 this cutoff point changed to 20 fatal plus nonfatal CVD risk Nowadays ‘the lower the risk factors the lower the absolute risk’ is the leading paradigm in CVD prevention

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