Cardiovascular Risk

Article written and reviewed by Dr Luca Moretti

Arterial hypertension is a major cardiovascular risk factor: the higher the blood pressure values, the higher the risk.
Furthermore, since hypertension is often associated with other diseases and risk factors, a correct risk stratification must consider the number and type of additional risk factors.

Repetition helps: hypertension is defined as:

• 
  Persistently elevated blood pressure values above 140 mmHg systolic and/or above 90 mmHg diastolic
  
  

Based on the severity of blood pressure values, different hypertension grades are distinguished, linked to increasing cardiovascular risk:

	Systolic Pressure (mmHg)	Diastolic Pressure (mmHg)
Optimal Pressure	<120	<80
Normal Pressure	120-129	80-84
Normal-High Pressure	130-139	85-89
Grade 1 Hypertension	140-159	90-99
Grade 2 Hypertension	160-179	100-109
Grade 3 Hypertension	≥180	≥110

Both normal and normal-high pressures are considered physiological values. Hypertension diagnosis is made for persistently elevated pressure values above 140 mmHg systolic and 90 mmHg diastolic.
Normal-high blood pressure is considered borderline and is also called prehypertension. Subjects with normal-high pressure are not hypertensive but have an increased probability of developing hypertension over time.
For a global evaluation of cardiovascular risk, the presence of other risk factors must also be considered, such as family history, obesity, dyslipidemia, diabetes, atherosclerosis, and other comorbidities with vascular impact.
It should be noted that hypertension often occurs within a more complex condition known as Metabolic Syndrome. Furthermore, its incidence increases with age, and elderly patients often have frailty, precarious homeostasis, multiple diseases, and polypharmacy.

Based on blood pressure levels and the presence or absence of other cardiovascular risk factors, different cardiovascular risk grades are distinguished:

Other Risk Factors	Normal Pressure	Normal-High Pressure	Mild Hypertension	Moderate Hypertension	Severe Hypertension
None	No additional risk	No additional risk	Low Risk	Medium Risk	High Risk
Up to 2 without diabetes	Low Risk	Low Risk	Medium Risk	Medium Risk	Very High Risk
More than 2 or with diabetes	Medium Risk	High Risk	High Risk	High Risk	Very High Risk
Cardiovascular or renal disease	Very High Risk	Very High Risk	Very High Risk	Very High Risk	Very High Risk
Cardiovascular risk means the increased probability of cardiovascular events within 10 years. Low Risk 15% or less Medium Risk 15-20% High Risk 20-30% Very High Risk > 30%

References
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