Beyond hypertension: Toward guidelines for cardiovascular risk reduction

Massimo Volpe, Michael H. Alderman, Curt D. Furberg, Rodney Jackson, John B. Kostis, John H. Laragh, Bruce M. Psaty, Luis M. Ruilope

Research output: Contribution to journalArticlepeer-review


Most current clinical guidelines focus primarily on the management of individual cardiovascular risk factors, such as high blood pressure (BP), hypercholesterolemia, or diabetes. A more appropriate clinical approach to reducing cardiovascular disease risk would be based on a comprehensive evaluation of risk profile, and accurate stratification of global (absolute) risk in individual patients. We propose that global risk should be used as the main determinant of whom to treat, how to treat, and how much to treat. In this article we use a series of case studies to demonstrate the implications of replacing the traditional single risk factor-based approach to managing hypertension by one based on global risk assessment. In some situations patients with mildly elevated BP levels would not be recommended for antihypertensive drug treatment whereas others with lower BP would be treated, depending upon the entire risk profile. We propose to replace the single risk factor-based approach with the assessment of global cardiovascular risk, both in the clinical management of individual patients and in guidelines.

Original languageEnglish
Pages (from-to)1068-1074
Number of pages7
JournalAmerican Journal of Hypertension
Issue number11
Publication statusPublished - Nov 2004


  • Cardiovascular disease
  • cardiovascular risk
  • diabetes
  • hypercholesterolemia
  • hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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