CV Mortality Risk
Doubles with each 20/10 mm Hg BP increment
CSRI
CV mortality:
-fold increase
8
7
6
5
4
3
2
1
0
115/75
135/85
155/95
BP (SBP/DBP mm Hg)
175/105
Long-term antihypertensive
treatment reduces CV risk
0
CV event
Stroke
CSRI
CHD
10
20
30
2021
2128
40
3039
50
Relative risk reduction (%)
CSRI
DBP/SBP uncontrolled
Major CV events/year*
50 000
DBP uncontrolled
SBP uncontrolled
40 000
30 000
20 000
10 000
0
Medicated
Unmedicated
Total
CSRI
CSRI
CSRI
CSRI
Harmonise guidelines
Focus on common areas of consensus
Remove boundary between primary and
secondary prevention
Focus on level of risk
Help policy makers to understand the different
component of CVD
Include professional societies from different
specialties in guidelines development and
implementation to increase ownership and
decrease fragmentation
Erhardt LR et al. Atherosclerosis 2008;196:532-41
CSRI
CSRI
CSRI
Hypertension
C.H.D.
CSRI
Diabetes
CSRI
Awareness** (%)
Treatment** (%)
Control** (%)
CSRI
CSRI
2000
2025
28
26
24
Overall
Men
Women
CSRI
Women
1
19%
CSRI
Obesity
1
17%
Glucose intolerance
26%
27%
Hyperinsulinaemia
4+
8%
Reduced HDL-C
4+
12%
Elevated LDL-C
22%
Elevated
triglycerides
25%
Left Ventricular
Hypertrophy
20%
24%
CSRI
CSRI
CSRI
CSRI
CSRI
30
25
20
15
10
5
0
<140 mmHg
140159 mmHg
Clinic systolic BP
160 mmHg
CSRI
CSRI
CSRI
Clinical Inertia
CSRI
CSRI
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
hypotension]
approach]
CSRI
Attitudes
Training
Knowledge and awareness of guidelines
Measurement issues
Clinical inertia
Reluctance to change treatment despite
failure to achieve targets
Lack of regular review
Co-morbidity
Organisation
Lack of follow-up
Migration
Failure to refer to specialist centres
CSRI
Doctor - Try this. If it doesnt work, come back and I will give you something else
Patient - Wouldnt it be better if you gave me that something else right now?