Page 12 - GUIAS ESC ESH 2018

12 ESC/ESH Guidelines

Table 5 Ten year cardiovascular risk categories (Systematic COronary Risk Evaluation system)

Very high risk People with any of the following:
Documented CVD, either clinical or unequivocal on imaging.
• Clinical CVD includes acute myocardial infarction, acute coronary syndrome, coronary or other arterial revascula-
rization, stroke, TIA, aortic aneurysm, and PAD
• Unequivocal documented CVD on imaging includes significant plaque (i.e. >_50% stenosis) on angiography or
ultrasound; it does not include increase in carotid intima-media thickness
• Diabetes mellitus with target organ damage, e.g. proteinuria or a with a major risk factor such as grade 3
hypertension or hypercholesterolaemia
2
• Severe CKD (eGFR <30 mL/min/1.73 m )
• A calculated 10 year SCORE of >_10%
High risk People with any of the following:
• Marked elevation of a single risk factor, particularly cholesterol >8 mmol/L (>310 mg/dL), e.g. familial hyper-
cholesterolaemia or grade 3 hypertension (BP >_180/110 mmHg)
• Most other people with diabetes mellitus (except some young people with type 1 diabetes mellitus and with-
out major risk factors, who may be at moderate-risk)

Hypertensive LVH
2
Moderate CKD eGFR 30-59 mL/min/1.73 m )
A calculated 10 year SCORE of 5-10%

Moderate risk People with:
• A calculated 10 year SCORE of 1to <5%
• Grade 2 hypertension
• Many middle-aged people belong to this category
Low risk People with:
• A calculated 10 year SCORE of <1%

BP = blood pressure; CKD = chronic kidney disease; CVD = cardiovascular disease; eGFR = estimated glomerular filtration rate; LVH = left ventricular hypertrophy; TIA =
transient ischaemic attack; PAD = peripheral artery disease; SCORE = Systematic COronary Risk Evaluation.

.
of people with hypertension will increase by 15–20% by 2025, reach- . . . hypertension with an increased risk of developing atrial fibrillation
ing close to 1.5 billion. 19 . . . . (AF), 20 and evidence is emerging that links early elevations of BP to
21,22
increased risk of cognitive decline and dementia.
3.4 Blood pressure relationship with risk . . . . . The continuous relationship between BP and risk of events has
of cardiovascular and renal events . . . . been shown at all ages 23 and in all ethnic groups, 24,25 and extends
Elevated BP was the leading global contributor to premature death in . . . from high BP levels to relatively low values. SBP appears to be a bet-
23,26,27
2015, accounting for almost 10 million deaths and over 200 million . . . ter predictor of events than DBP after the age of 50 years.
3
disability-adjusted life years. Importantly, despite advances in diagno- . . . High DBP is associated with increased CV risk and is more commonly
sis and treatment over the past 30 years, the disability-adjusted life . . . elevated in younger (<50 years) vs. older patients. DBP tends to
years attributable to hypertension have increased by 40% since . . . decline from midlife as a consequence of arterial stiffening; conse-
3
1990. SBP >_140 mmHg accounts for most of the mortality and dis- . . . quently, SBP assumes even greater importance as a risk factor from
26
ability burden (70%), and the largest number of SBP-related deaths . . . midlife. In middle-aged and older people, increased pulse pressure
per year are due to ischaemic heart disease (4.9 million), haemor- . . . (the difference between SBP and DBP values) has additional adverse
28,29
rhagic stroke (2.0 million), and ischaemic stroke (1.5 million). 3 . . . prognostic significance.
Both office BP and out-of-office BP have an independent and con- . . .
.
tinuous relationship with the incidence of several CV events [hae- . 3.5 Hypertension and total
.
.
morrhagic stroke, ischaemic stroke, myocardial infarction, sudden . cardiovascular risk assessment
.
.
death, heart failure, and peripheral artery disease (PAD)], as well as . . . Hypertension rarely occurs in isolation, and often clusters with other
4
end-stage renal disease. Accumulating evidence is closely linking . CV risk factors such as dyslipidaemia and glucose intolerance. 30,31
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