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Halfdan Petursson Linn Getz Johann Agust Sigurdsson Irene Hetlevik

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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Halfdan Petursson Linn Getz Johann Agust Sigurdsson Irene Hetlevik

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  1. 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

  2. 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?)

  3. 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

  4. Treatment recommendations 0 2 3-4 3-4

  5. 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

  6. Exclusion criteria • Excluded if: • blood pressure <120/80 mmHg • no information available about any of the other risk factors

  7. 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

  8. Age standardised prevalence Total: 100% = 100 000 adults after standardisationData from those included only (51 066)

  9. Age standardised prevalence

  10. Age standardised prevalence The excluded group Averagerisk 6.6% + Low risk? <21% = <25% Do 75% or more haverisk above average?

  11. 99% of all 50-64 y.o. should attend regular follow-up visits or receive drug treatment for high bp! Average risk?6,6%

  12. 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

  13. 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

  14. 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

  15. Treatment recommendations 0 2 3-4 3-4

  16. Mortality from CVD per 100.0001970-2006 WHO Health for all database, Aug 2008

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