Total (global) cardiovascular risk makes up an important part of the new guidelines. The committee points out that hypertension is often accompanied by other risk factors. Total cardiovascular risk quantification allows more accurate prognostic evaluation of the patient. The timing and type of antihypertensive treatment depend on this profile, and the blood pressure threshold and targets for therapy are modified, and the need for accompanying antihypertensive treatment modulated, by it.

Because of this, the classification using stratification for total cardiovascular risk has been expanded from the scheme in the 1999 WHO/ISH guidelines to indicate the added risk in some groups of individuals with normal or high blood pressure (Table 2).

Table 2. Stratification of Risk to Quantify Prognosis

ACC = associated clinical conditions; TOD = target organ damage
The total level of risk is the main indication for intervention, but lower or higher pressure values are also more or less stringent indicators for blood pressure-lowering intervention. The terms "low added," "moderate added," "high added," and "very high added" risk are calibrated to indicate an approximate absolute 10-year risk of cardiovascular disease of < 15%, 15% to 20%, 20% to 30%, and > 30% added risk, respectively, according to Framingham criteria,[7] or an absolute risk of fatal cardiovascular disease of < 4%, 4% to 5%, 5% to 8%, and > 8%, respectively, according to the SCORE (Systemic Coronary Risk Evaluation) chart.[8] The word "added" is used because it accounts for an increase in relative risk and, for example, could negate the misleading impression that patients at "low risk" are below average risk (they are actually at low added risk).
The most common risk factors for cardiovascular disease used for stratification are:
1. Levels of SBP/DBP
2. Men aged > 55 years
3. Women aged > 65 years
4. Smoking
5. Dyslipidemia
o Total cholesterol > 6.5 mmol/L (> 250 mg/dL)

or
o LDL-cholesterol > 4.0 mmol/L (> 155 mg/dL)

or
o HDL-cholesterol :
" Men: < 1.0 mmol/L (< 40 mg/dL);
" Women: < 1.2 mmol/L (< 48 mg/dL)
6. Family history of premature cardiovascular disease (men < 55 years, women < 65 years)
7. Abdominal obesity (abdominal circumference >/= 102 cm [40 in] in men, 88 cm [35 in] in women)
8. C-reactive protein >/= 1 mg/dL
Obesity is defined as abdominal obesity to draw attention to an important sign of the metabolic syndrome (carrying extra weight may not be a problem, unless it is all carried around the abdominal girth). C-reactive protein was added after increasing evidence pointed to its value as a predictor of cardiovascular events; it has been shown to be as reliable a predictor as LDL-cholesterol levels, and because of CRP's association with the metabolic syndrome.
The importance of target organ damage (TOD) for determining overall cardiovascular risk is also emphasized. The practicing physician should seek evidence for organ involvement, including electrocardiogram/echocardiogram investigations for left ventricular (LV) hypertrophy, ultrasound evidence of arterial wall thickening or atherosclerotic plaque, slight increase in serum creatinine, and microalbuminuria.
Other factors the guidelines points to as influencing prognosis are the presence/absence of diabetes mellitus and of associated clinical conditions, including cerebrovascular disease, heart disease, renal disease, peripheral vascular disease, and advanced retinopathy.

编辑 郑麓薇