Preventing XXXX in @entity101 : effects of lowering blood pressure and @entity165 .

@entity1 @entity64 @entity101 @entity6 @entity301 @entity1780 @entity65 @entity165
BACKGROUND: In guidelines for the primary prevention of @entity65 , systolic blood pressure (SBP) or diastolic blood pressure (DBP) is treated with medication at lower levels of risk than those at which @entity1780 treatment is recommended for @entity165 lowering. AIM: To compare the potential benefits of antihypertensive medication and @entity1780 therapy in @entity101 @entity1 , and examine whether this policy is rational. DESIGN: Retrospective cross-sectional survey. METHODS: We studied 146 @entity1 and 150 @entity1 aged 56 (54-58) (mean (95% CI)) years and 60 (58-62) years, respectively, who had commenced drug therapy for @entity101 within 10 years in five general practices in Greater Manchester. @entity301 ( @entity301 ) and @entity64 risk were calculated, and the potential benefit of blood pressure lowering treatment and @entity1780 therapy estimated using the results of published meta-analyses of clinical trials. RESULTS: Blood pressure before treatment was initiated was 176 (173-179)/102 (100-104) mmHg in @entity1 and 176 (172-179)/98 (96-100) mmHg in women. Serum @entity165 was 5.7 (5.5-5.9) mmol/l and high density lipoprotein (HDL) @entity165 1.3 (1.2-1.4) mmol/l in @entity1 . The corresponding values in @entity1 were 6.3 (6.1-6.5) mmol/l and 1.5 (1.4-1.6) mmol/l. Of the @entity1 , 44% (36-52%) smoked and 23% (17-31%) had @entity6 , whereas 27% (20-35%) of the @entity1 smoked and 26% (19-34%) had @entity6 . These risk factors gave the combined group of @entity1 and @entity1 a @entity301 risk of 19.7% (12.0-28.0%) (median (IQR)) and a @entity64 risk of 8.8% (3.8-13.9%) over the next 10 years. All @entity1 were prescribed antihypertensive medication and 15% subsequently received @entity1780 treatment. The 10-year @entity301 risk would be expected to decrease to 16.5% (10.1-23.5%) on anti- @entity101 therapy. Had @entity1780 treatment been given instead, it would have been reduced to 13.2% (8.05-18.7%). For @entity64 , the 10-year risk on antihypertensive therapy was calculated as 5.5% (2.4-8.6%) and on @entity1780 6.2% (2.7-9.9%). This meant that combined @entity301 and @entity64 risk would be reduced from 29.4% (17.5-41.5%) to 22.4% (17.5-41.5%) on antihypertensive therapy and to 20.1% (11.9-28.2%) on statins. The difference between @entity1780 and antihypertensive therapy was statistically significant (p<0.0001). DISCUSSION: Because the object of drug treatment in mild-moderate @entity101 is to reduce @entity65 risk and not simply to decrease blood pressure, current recommendations and practice should be revised so that more @entity1 can benefit from evidence-based therapy favouring a more holistic approach, including @entity165 -lowering therapy.
