Overwhelming evidence has been available for decades that classic risk factors such as hypertension and/or dyslipidaemia lead to an increased risk of chronic disease such as heart failure, coronary heart disease, stroke, vascular dementia, chronic kidney disease and peripheral vascular disease. These cardiovascular risk factors and their related diseases are in large part the consequence of an unhealthy lifestyle, which is facilitated by the structure of modern industrialised societies. There is a ready availability of excess calories and workplace-induced inactivity with subsequent obesity, as well as tobacco and alcohol use and excessive sodium consumption.1 Individuals without these unhealthy lifestyles are largely protected from hypertension and dyslipidaemia.2 The implementation of population-based preventative strategies is a major challenge to governments and healthcare services. As individuals have been required to take responsibility for the adverse health consequences of modern society, it is not surprising that inadequate lifestyle intervention is a major barrier to improved outcomes.
The global impact on health policy and the economic burden of hypertension-related disease alone is astounding.3 Up to one billion people are hypertensive (with this figure expected to rise by at least 60% in the next 20 years) and an there is an accelerating contribution from both the ageing populations of industrialised countries and the rapid industrialisation of nations such as India and China. There are over seven million deaths per year from hypertension-related disease and many more debilitating events. Hypertension is responsible for about half of the 7.2 million fatal myocardial infarcts per year. It is the major cause of heart failure and chronic kidney disease and the primary risk factor for over 15 million strokes per year. This epidemic of vascular and renal disease threatens to overwhelm health services worldwide.3 The cost of treating hypertension and its complications in the US approaches US$60 billion per year.4
There are compelling data confirming that the treatment of these risk factors significantly reduces the incidence of related disease.5 Therapy of hypertension reduces the incidence of myocardial infarction by 20–25%, heart failure by more than 50% and stroke by 35–40%, and significantly retards the progression of chronic kidney disease to its end stage requiring dialysis or transplantation.6
Vascular and renal risk factors rarely exist in isolation. Improved outcomes require assessment of total cardiovascular risk and the targeting of these multiple risk factors, including lifestyle contributors.
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- Villegas R, Kearney PM, Perry IJ, The cumulative effect of core lifestyle behaviours on the prevalence of hypertension and dyslipidemia, BMC Public Health, 2008;8:210–17.
- Kanavos P, Ostergren J, Weber M, High Blood Pressure and Health Policy: Where We Are and Where We Need to Go Next, New York: Ruder Finn Inc., 2007,
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- Neal B, MacMahon S, Chapman N, Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: Results of prospectively designed overviews of randomised trials-Blood Pressure Lowering Treatment Trialists’ Collaboration, Lancet, 2000;356:1955–64.
- Samak MJ, Greene T, Wang X, et al., The effect of a lower target blood pressure on the progression of kidney disease- Long-term follow-up of the modification of diet in renal disease study, Ann Int Med, 2005;142:342–51.
- Guidelines Subcommittee, World Health Organisation- International Society of Hypertension Guidelines for the Management of Hypertension, J Hypertens, 1999;17:151.
- Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, Hypertension, 2003;42(6):1206.
- The Australian Diabetes Study—Diabetes and Associated Disorders in Australia—2000, The Accelerating Epidemic. National Diabetes Strategy 2000–2004, Commonwealth Department of Health and Aged Care, Canberra 2001.
- Nag SS, Daniel GW, Bullano MF, Goal-attainment among patients newly diagnosed with coronary heart disease or diabetes in a commercial HMO, J Manag Care Pharm, 2007;13:652–63.
- Graves J, Does evidence-based medicine suggest that physicians should not be measuring blood pressure in the hypertensive patient?, Am J Hypertens, 2004;17(4):354–60.
- McKenney J, Improving cholesterol control in managed care populations, Am J Mang Care, 2000;6:S997–S1007.
- Burnier M, Medication adherence and persistence as the cornerstone of effective antihypertensive therapy, Am J Hypertens, 2006;19(11):1190–96.
- Munger MA, Van Tassell BW, LaFleur J, Medication nonadherence: an unrecognised cardiovascular risk factor, Med Gen Med, 2007;9(3):58.
- Craney M, et al., Why do GPs not implement evidence-based guidelines? A descriptive study, Family Practice, 2001;18(4):359.
- Hyman DJ, Pavlik VN, Self-reported hypertension treatment practices among primary care physicians: blood pressure thresholds, drug choices and the role of guidelines and evidence-based medicine, Arch Intern Med, 2001;161(11):1458.
- Hyman DJ, Pavlik VN, Self-reported hypertension treatment practices among primary care physicians: blood pressure thresholds, drug choices and the role of guidelines and evidence-based medicine, Arch Intern Med, 2000;160(15): 2281–6.
- Oliveria SA, et al., Physician-related barriers to the effective management of uncontrolled hypertension, Arch Intern Med, 2002;162(4):413–20.
- Green BB, Cook AJ, Ralston JD, et al., Effectiveness of Home Blood Pressure Monitoring, Web Communication and Pharmacist Care on Hypertension Control: A Randomised Controlled Trial, JAMA, 2008;299(24):2857–67.