Office assessment of coronary candidates and risk factor insights from the Framingham study

Hypertension is a major risk factor for cardiovascular disease, particularly coronary heart disease. Risk increases with the severity of hypertension, irrespective of age or sex. However, the absolute risk is greatest in the elderly, for whom isolated systolic hypertension is particularly important. Hypertension is often accompanied by other risk factors. For example, the levels of cholesterol and high- and low-density lipoproteins are important. Diabetes increases the risk of cardiovascular disease at any level of blood pressure. Smoking increases the risk from hypertension and stopping smoking can dramatically reduce risk. A raised heart rate increases the risk of coronary events in both hypertensive and normotensive patients. However, heart rates tend to be higher in hypertensive patients. Left ventricular hypertrophy combined with hypertension increases the risk of coronary heart disease. An elevated level of fibrinogen increases the risk of cardiovascular disease in both hypertensive and normotensive patients, though the risk is greater at higher blood pressures. Cardiovascular risk profiles have been constructed to identify patients at high risk.