Residual risk in treated hypertension

It is often assumed that full correction of risk factors can reduce cardiovascular outcome incidence to the same level in patients with a previous history of cardiovascular disease as in individuals free of cardiovascular disease. The evidence summarized in this chapter suggests that this assumption is incorrect: when organ damage is advanced and overt disease is present, a high incidence of cardiovascular events persists despite intense BP lowering and the concurrent therapeutic correction of other risk factors, such as serum cholesterol and platelet aggregation. This does not deny the known benefit of interventions even in secondary prevention, but it points out that a pre-existing high risk sets a ceiling effect to the benefits of treatment because of a residual risk that is either not amenable or scarcely amenable to be reduced by treatment. The existence of a consistent residual risk in high-risk patients underlines the limitations of late interventions and suggests that the recommendations by many private or public health-care providers to limit interventions to patients with total cardiovascular risk above 20 % in 10 years may be unwise.