Clinical Perspective
-We often lose sight of the purpose of achieving a given BP target. The reading in and of itself is meaningless. Its value derives from the association between a given BP and CV event rates. However hypertension is but one precipitant of atherosclerotic sequelae.
-Predictive models that incorporate multiple variables (eg tobacco use, diabetes) are more accurate. They also reveal which risk factor may be disproportionately contributing to a patient's risk profile and thus identify the most important target for therapy.
-In the above vignette, the prescriber could have lowered the patient's BP to the guideline recommended level of 120 systolic. With the assistance of a risk calculator, one quickly appreciates that her LDL of 95 mg/dl is unexpectedly contributing more to her CV risk than her current degree of hypertension. Because a moderate-intensity statin is often better tolerated than a reduction of BP from 130 to 120 mm Hg, it is the intervention of choice should optimization of both parameters be prohibitive.
-This calculator can be found
online.
I prefer this simplified
printed version
which permits the patient and me to jointly explore how tobacco use or aging impacts CV event rates.
-Study Shortcomings: This risk calculator was derived from a white population with a maximum age of 74. While it performs well in black populations, more accurate risk models exist for other groups.
-Disclosures: I have no conflicts to declare.
