A New Classification Scheme for Hypertension Based on Relative and Absolute Risk

A New Classification Scheme for Hypertension Based on Relative and Absolute Risk With Implications for Treatment and Reimbursement.

Classification schemes for hypertension are necessary. They provide us with definitions for when hypertension begins and help us to assess risk, determine prognosis, and guide management. Systems in current use rely on either the level of blood pressure (diastolic, systolic, or both) and classify patients based on the level of relative risk (the proportional likelihood of cardiovascular events occurring as blood pressure rises), absolute risk (the actual odds that a patient or a population will develop an event), or both.

Absolute risk reflects the sum of all the factors that contribute to the likelihood that a patient will experience cardiovascular disease. The system we propose stages hypertensive individuals on the basis of blood pressure level (as does the Fifth Joint National Committee report on the detection, evaluation, and treatment of High Blood Pressure [JNC-V] and the World Health Organization/International Society of Hypertension guidelines) but uses different levels for each stage than do the previous systems and then modifies the numerical stage with the subscript “c” for complicated (when target-organ damage and/or other cardiovascular risk factors are present) or “u” for uncomplicated (when they are absent).

The data obtained from a complete medical history and physical examination and a few inexpensive laboratory tests provide the information a provider needs to classify an individual as being complicated or uncomplicated. This system also provides a guide to treatment, as drug therapy would be used sooner in individuals with complicated hypertension, and we propose that compensation for providers be higher when they are caring for a patient with complicated rather than uncomplicated hypertension.

The objective of defining and classifying hypertension is not simply to ascertain when hypertension starts and normotension ends. Classification schemes are necessary because they provide us with definitions as to when hypertension begins and help us assess risk, determine prognosis, and ascertain when and how aggressively to treat. If clinicians are better able to select individuals at high risk, their therapeutic efforts to prevent complications are much more likely to be effective and spare those at low risk from the potential harm of unnecessary or overaggressive therapy.

The ideal classification scheme should be simple but comprehensive. It should identify those individuals at high risk and provide a guide to management. Since hypertension is both a disease (a disturbance in normal physiology) and a risk factor (a characteristic that increases the likelihood that an individual will develop a disease), the scheme should provide a guide to prognosis and help identify people who can expect to benefit most from treatment—an especially valuable feature from medical and economic perspectives.

full text
Henry R. Black; Jong-Yoon Yi
the Department of Preventive Medicine, Rush–Presbyterian–St Luke’s Medical Center, Rush Medical College of Rush University, Chicago, Ill.

Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206-52. [Medline].

RELATED STORIES:
Drinking black tea may cut blood pressure   Middle-aged men with upper-normal blood pressure at risk for AF   Pollution tied to disease risk in L.A. black women   Birth Defects May be Linked to High Blood Pressure, Not Use of ACE Inhibitors   Poor sleep quality increases risk of high blood pressure   Pilot study suggests new approach to treat preeclampsia   Living with a smoker may raise blood pressure in boys   Vitamin D May Help Explain Racial Differences in Blood Pressure   Research shows blood protein levels may predict risk of a cardiovascular event: Study   Redefining normal blood pressure   New Home Blood Pressure Check Created for Diabetics   Neighborhood Barbers Can Influence Black Men to Seek Blood-Pressure Treatment

Now you're in the public comment zone. What follows is not Armenian Medical Network's stuff; it comes from other people and we don't vouch for it. A reminder: By using this Web site you agree to accept our Terms of Service. Click here to read the Rules of Engagement.

There are no comments for this entry yet. [ + Comment here + ]

Interactive Quiz:

1. The most common form of contraception used by couples in the United States is Pills Condom Diaphragm Intrauterine device (IUD) Permanent sterilization