Current European guidelines for management of arterial hypertension: Are they adequate for use in primary care? Modelling study based on the Norwegian HUNT 2 population
Abstract
Background: Previous studies indicate that clinical guidelines using combined risk evaluation for
cardiovascular diseases (CVD) may overestimate risk. The aim of this study was to model and
discuss implementation of the current (2007) hypertension guidelines in a general Norwegian
population.
Methods: Implementation of the current European Guidelines for the Management of Arterial
Hypertension was modelled on data from a cross-sectional, representative Norwegian population
study (The Nord-Trøndelag Health Study 1995-97), comprising 65,028 adults, aged 20-89, of whom
51,066 (79%) were eligible for modelling.
Results: Among individuals with blood pressure ≥120/80 mmHg, 93% (74% of the total, adult
population) would need regular clinical attention and/or drug treatment, based on their total CVD
risk profile. This translates into 296,624 follow-up visits/100,000 adults/year. In the Norwegian
healthcare environment, 99 general practitioner (GP) positions would be required in the study
region for this task alone. The number of GPs currently serving the adult population in the study
area is 87 per 100,000 adults.
Conclusion: The potential workload associated with the European hypertension guidelines could
destabilise the healthcare system in Norway, one of the world's most long- and healthy-living
nations, by international comparison. Large-scale, preventive medical enterprises can hardly be
regarded as scientifically sound and ethically justifiable, unless issues of practical feasibility,
sustainability and social determinants of health are considered.