5.1 Cardiovascular Risk Assessment

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The presence of one or more additional cardiovascular risk factors proportionally increases the risk of coronary, cerebrovascular and renal diseases in hypertensive patients. The overall cardiovascular risk should be taken into consideration and patients need to be stratified according to the overall risk of development of CVD. Despite the availability of many CVD risk charts, all have shortcomings, particularly for administering in developing countries such as Bangladesh. The use of the risk assessment chart for taking decision to start treatment requires interpretation by the qualified physicians and resources to identify associated clinical conditions (ACC) or target organ damage. However, in a low resource setting like Bangladesh primary care physicians and trained health assistants are expected to do the detection and referral at primary health care level. In this situation diagnosis of hypertension and decision to refer should be based on the clinic blood pressure only10.

  • Most patients with SBP 140 ≥ or DBP ≥90 mmHg are at high risk and indicated for pharmacological treatment; they do not require cardiovascular (CVD) risk assessment prior to initiating treatment.
  • CVD risk assessment is most important for guiding decisions about initiating pharmacological treatment for hypertension (HTN) in those with lower SBP (130–139 mmHg). It is critical for those with HTN that other risk factors must be identified and treated appropriately to lower total cardiovascular risk.
  • Whenever risk assessment may threaten timely initiation of HTN treatment and/or patient follow up, it should be postponed and included in the follow-up strategy, rather than taken as a first step to initiate treatment.
  • It is recommended to use WHO cardiovascular diseases risk chart for South Asia estimation of CVD risk [Annexure 2]. HEARTS technical package for cardiovascular disease management in primary health care: risk-based CVD management published by World Health Organization; 2020 may be consulted for detail discussion on CV risk assessment17.