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Awareness, treatment and control of hypertension: the ‘rule of halves’ in an era of risk-based treatment of hypertension

A Corrigendum to this article was published on 18 January 2007


Detection, treatment and control of high blood pressure in many populations are insufficient. We reported current prevalence, awareness, treatment and control of hypertension in the Netherlands and compared the findings with other studies. Furthermore, we related actual treatment of hypertension to estimated absolute 10-year cardiovascular risk, as according to current guidelines on this subject, initiation of blood pressure-lowering treatment depends on the level of cardiovascular risk. The Utrecht Health Project is a prospective cohort study in a suburb of Utrecht. Information on medical history, life style and measurements of blood pressure, cholesterol and glucose of the first 4950 participants of the study was obtained. Cardiovascular risks were calculated using the Framingham risk function. Prevalence of hypertension was 23.3%. Among those with hypertension, 33.7% was aware of the condition. Of those aware, 59.4% was treated. Of those treated, 41.9% had blood pressure below the recommended level. In half of those aware of their hypertension, and a calculated cardiovascular risk less than 10%, treatment of hypertension was started unnecessary. Of those aware of their hypertension with a calculated cardiovascular 10 years risk exceeding the treatment threshold of 20%, treatment was absent in 33.6%. Awareness and control of hypertension are still inadequate in the Netherlands and comparable with other European countries. Management of hypertension is too often not risk-based despite recommendations in guidelines on prevention of cardiovascular diseases available since 2000.

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We gratefully acknowledge the contribution of the general practitioners of the Julius Health Centres Leidsche Rijn: MJC Arnold, NAA Beelen (till 2003), LGM van Berkestijn, CSM Biessels-Oude Elberink, CJ Bijkerk, P Blommendaal, M Buikman, MM van Eenige, J Geurts, MG Giezeman, HE Hart, FJ ten Hove, GJB Hurenkamp, MJJ de Kleijn, JPJM van Langen, CT den Ouden, H Smits-Pelser, TJM Verheij, MM de Vos (2000). Sources of support: The Utrecht Health Project LRGP is supported by grants from the Ministry of Health, Welfare, and Sports (VWS), the University of Utrecht, the Province of Utrecht, the Dutch Organisation of Care Research (ZON), the University Medical Centre of Utrecht (UMC Utrecht) and the Dutch College of Healthcare Insurance Companies (CVZ).

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Correspondence to T Scheltens.

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Scheltens, T., Bots, M., Numans, M. et al. Awareness, treatment and control of hypertension: the ‘rule of halves’ in an era of risk-based treatment of hypertension. J Hum Hypertens 21, 99–106 (2007).

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