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Thursday, 9 March, 2000, 22:07 GMT
Heart disease 'could be cut by two-thirds'
Blood pressure
The report calls for an increase in treatment offered
Better targeting of blood pressure treatment could greatly reduce cases of heart disease and stroke, say researchers.

A report in the British Medical Journal says that taking into account the risk of heart disease and stroke, as well as blood pressure levels, would increase survival rates by two-thirds.


Implementing a 10% threshold for a five-year risk of cardiovascular disease would increase the proportion of events averted by two-thirds

Professor Rod Jackson
The point at which all patients should receive treatment should be raised to a blood pressure level of 170 over 100, the researchers said.

But people with lower blood pressure who have a predicted five-year risk of heart disease or stroke of 10% or higher, should also receive drug treatment, said the team at the University of Auckland, New Zealand.

Some people currently receiving treatment do not need it, while thousands of others should be given drugs for the first time, they add.

The team, led by Professor Rod Jackson, calculated that an overall increase in the number of people who receive treatment by 42% would give a 68% fall in cases of cardiovascular disease - heart disease and stroke.

Currently, 12% of Auckland residents aged 35 to 79 years old - 46,374 people - receive blood pressure treatment. The researchers said 13,221 of these should be taken off treatment because they did not meet the criteria for high risk, while 32,662 new cases should be added.

Professor Jackson said: "Using the risk of cardiovascular disease to set thresholds for drug treatment of hypertension in primary care could significantly improve the efficiency of the management of risk."

He added: "Implementing a 10% threshold for a five-year risk of cardiovascular disease would increase the proportion of events averted by two-thirds."

Hypertension

Treatment should be available to all people with blood pressure, also known as hypertension, at or above 170 over 100, rather than threshold currently set in New Zealand of 150 over 90, he said.

But, he added, it should also be given to patients with a blood pressure between 150 over 90 and 169 over 99 who have a five year risk of disease of 10% or higher, taking into account age, sex, systolic blood pressure, cholesterol levels, smoking and diabetes.

A spokesman for the Stroke Association said: "The work by the Auckland team highlights the need to quantify each person's absolute risk of a stroke when deciding to treat their high blood pressure.

"This is a rational starting point in the management of hypertension."

The charity said the suggested approach was increasingly being used by GPs in the UK.

Late last year a group of organisations, including the British Hypertension Society (BHS), published new clinical guidelines based on the same principle as Jackson's study.

Professor Neil Poulter, secretary of the BHS, said: "We grossly under-treat in the UK. In 1994, only 30% of hypertensives were getting to the conservative target of 160 over 95. It is improving, but that is appalling."

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