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Halfdan Petursson Linn Getz Johann Agust Sigurdsson Irene Hetlevik

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Current European guidelines for management of arterial hypertension: Are they adequate for use in primary care?. Halfdan Petursson Linn Getz Johann Agust Sigurdsson Irene Hetlevik. Objectives.

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Presentation Transcript
slide1

Current European guidelines for management of arterial hypertension: Are they adequate for use in primary care?

Halfdan Petursson

Linn Getz

Johann Agust Sigurdsson

Irene Hetlevik

objectives
Objectives
  • To model the implications of recent European guidelines for the management of arterial hypertension
    • Prevalence of individuals “at risk” for CVD
    • Clinical workload associated with recommended measures
      • Number of follow-up visits/year
      • Number of physicians needed (general practitioners?)
slide4
Treatment recommendations are based on combined risk estimate
  • “A new” risk factor:
    • High pulse pressure* in the elderly
      • No further definition in the guidelines!
      • ≥ 60 mmHg in individuals > 55 years of age

* Pulse pressure = Systolic BP – diastolic BP

hunt 2
HUNT 2
  • Every adult invited
  • Participation > 2/3
    • 76% of women
    • 67% of men
  • 65,028 individuals 20-89 years old
  • 51,066 (79%) eligible for our model
exclusion criteria
Exclusion criteria
  • Excluded if:
    • blood pressure <120/80 mmHg
    • no information available about any of the other risk factors
the risk factors
HUNT 2

Age

Smoking

Dyslipidemia (total- and HDL cholesterol)

Waist circumference

1° relatives with CVD

Pulse pressure of the elderly

Guidelines but not HUNT 2

Fasting blood values: triglycerids, glucose, LDL

Left ventricular hypertrophy indicated on echo/EKG

Renal disease, microalbuminuria

The risk factors
age standardised prevalence
Age standardised prevalence

Total: 100% = 100 000 adults after standardisationData from those included only (51 066)

age standardised prevalence2
Age standardised prevalence

The excluded group

Averagerisk

6.6%

+

Low risk?

<21%

= <25%

Do 75% or more haverisk above average?

slide12

99% of all 50-64 y.o. should attend regular follow-up visits or receive drug treatment for high bp!

Average risk?6,6%

how many physicians are needed
How many physicians are needed?

Follow-up visits / 100,000 adults / year = 296,624

Number of GP positions = 296,624 / 3,000 consultations / year = 99

  • 99 physicians needed for bp control only per 100,000 adults
  • Current status in Nord-Trøndelag:
    • 87 GPs / 100,000 adults
conclusions
Conclusions
  • Clinical practice guidelines overestimate the risk
  • Fail to define a manageable number of people “at risk”
  • Fundamental problem regarding the theoretical framework
  • Only ethically justifiable if
    • practical feasibility,
    • sustainability, and
    • social determinants of health are considered
funding
Funding
  • Funding:
    • The Icelandic Family Physicians Research Fund
  • HUNT 2
    • HUNT Research Center, Faculty of Medicine NTNU
    • Norwegian Institute of Public Health
    • Nord-Trøndelag County Council
    • Levanger Hospital, Nord-Trøndelag
slide19

Mortality from CVD per 100.0001970-2006

WHO Health for all database, Aug 2008

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