7th Brazilian Guideline of Arterial Hypertension: Cardiovascular Risk Stratification.
Introduction
The global CV risk should be assessed in each hypertensive individual, because it aids the professionals in
therapeutic decision-making and allows prognostic analysis. The identification of hypertensive individuals prone to CV complications, especially myocardial infarction (MI) and stroke, is fundamental to a more aggressive therapy. Several algorithms and risk scores based on population studies were created in past decades,1 but, considering the lack of Brazilian data for a more accurate assessment of CV risk in the Brazilian population, the use of one single risk score should be avoided to support therapeutic decisions.
Multifactorial models of risk stratification can be used for a more accurate individual risk classification.
Informing patients about their RF can improve the efficacy of pharmacological and non-pharmacological measures to reduce global risk. In addition, estimating indicators and using aging-related terms, such as “vascular age” or “cardiometabolic age”, can aid in the strategy to change the RF.2,3 See below some electronic addresses to estimate the vascular or cardiometabolic age recommended by American, Canadian and British societies.4-6
1. www.framinghamheartstudy.org/risk-functions/cardiovascular-disease/10-year-risk.php
→ supported by the National Heart, Lung, and Blood Institute and Boston University
2. www.nhs.uk/Conditions/nhs-health-check/Pages/check-your-heart-age-tool.aspx
→ supported by the British Heart Foundation
3. cardiometabolicage.com
→ supported by the Canadian Institute for Health Research (CIHR) and McGill University
In clinical practice, CV risk stratification of hypertensive patients can be based on two different strategies. In the first, the assessment is aimed at determining the global risk directly related to hypertension, in which case the risk classification depends on BP levels, associated risk factors, TOD and presence of CVD or kidney disease. In the second strategy, the objective is to determine the risk
of a certain individual to develop general CVD within 10 years. Although that form of assessment is not specific to hypertensive patients, since it can be applied to any individual aged 30-74 years, it is worth noting that AH is the major CVRF.
Arquivos Brasileiros de Cardiologia (Impresso), v. 1, p. 1, 2016.