The concept of doctor targets based on quality guidelines: focus on blood pressure
Garfield Weston Chair of Cardiovascular Medicine, Imperial College, London, UK
Corresponding author. E-mail address: d.wood{at}imperial.ac.uk
Clinicians are taught to diagnose and manage disease starting with the question does this patient have disease or not—yes or no. As a consequence, cardiovascular risk factors were viewed historically as being dichotomous. However, over the past decade, there has been a shift towards the concept of total cardiovascular risk as the primary determinant for making clinical decisions about treating individual risk factors. This change is reflected in the European guidelines, developed by the European Society of Cardiology in partnership with the European Society of Hypertension and the European Atherosclerosis Society, in a common approach to coronary and subsequently cardiovascular disease (CVD) prevention. Cardiovascular risk is strongly related to lifestyle, a high saturated fat diet, physical inactivity, and smoking tobacco. Thus, lifestyle changes are at the heart of guidelines. Patients with established CVD have declared themselves to be at high total risk of a further vascular event and, therefore, they require the most intensive intervention, including appropriate drug therapies, in order to achieve risk factor goals including a systolic blood pressure < 140 mmHg and a diastolic blood pressure < 90 mmHg. Similarly, patients with a high total cardiovascular risk, and patients with diabetes, can benefit from reducing blood pressure below 140/90 mmHg or even lower. Despite wide awareness of guidelines, recent European surveys show that one-quarter of the patients with elevated blood pressure were unaware of their hypertensive status. There is also a high prevalence of elevated blood pressure in patients with established coronary heart disease, half of whom require more intensive blood pressure management and, where appropriate, antihypertensive medication. The challenge for primary prevention in people at high risk of developing CVD is even greater.
Key Words: Total cardiovascular risk • Blood pressure • Targets
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