[Guidelines for pharmacological primary prevention of cardiovascular diseases--who should be treated?]

Abstract

Background: Several clinical practice guidelines for the treatment of hypertension and hypercholesterolaemia are available. The quality of these guidelines varies and the basis for their conclusions is often not clear. We have used systematic and explicit methods in the development of a new set of recommendations. This is the first of three articles describing these guidelines.

Material and methods: Evidence was found by a systematic search in databases and reference lists in guidelines and articles. A set of recommendations was prepared based on a critical appraisal of the literature. These recommendations were revised through discussions with a panel of physicians and agreed upon after several iterations. The guidelines were circulated to professional, governmental and patient organisations, with a request for feedback on errors or shortcomings.

Results and interpretation: The absolute risk of cardiovascular disease should be used as the basis for discussing with a patient whether drug treatment should be initiated. A 20% risk of developing angina or myocardial infarction over the next ten years is a reasonable threshold for considering treatment. The effects of antihypertensives for persons older than 80 years and of cholesterol-lowering drugs for persons older than 70 years are uncertain. Treatment of blood pressure above 170/100 mm Hg is recommended independent of the risk of cardiovascular disease.