Review2007 ESH/ESC Guidelines for the management of hypertension, from theory to practice: global cardiovascular risk conceptVolpe, Massimoa; Tocci, GiulianobAuthor Information aDivision of Cardiology, II Faculty of Medicine, University of Rome ‘La Sapienza’, Sant'Andrea Hospital, Rome, Italy bIRCCS Neuromed, Pozzilli, IS, Italy Correspondence to Massimo Volpe, Division of Cardiology, II Faculty of Medicine, University of Rome ‘La Sapienza’, Sant'Andrea Hospital, Via di Grottarossa, 1035 00189 Rome, Italy Tel: +39 06 3377 5654; fax: +39 06 3377 5061; e-mail: [email protected] Conflicts of interest: None. Journal of Hypertension: June 2009 - Volume 27 - Issue - p S3-S11 doi: 10.1097/01.hjh.0000356766.86388.e5 Buy Metrics Abstract Clinical evaluation of cardiovascular risk in patients with hypertension is evolving from independently assessing well-known, traditional risk factors (e.g. hypertension, hypercholesterolemia, obesity, diabetes mellitus, smoking) towards an integrated, multidisciplinary clinical approach, aimed at determining the global (or total) cardiovascular risk profile in each individual patient for planning early and effective strategies for cardiovascular prevention. A paradigmatic example is provided by hypertension, in which new clinical behaviour implies a shift from focusing only on high blood pressure levels towards a more integrated approach, aimed at identifying and reducing global cardiovascular risk, as is highlighted in the European Guidelines. This approach arises from the acknowledgement that a cluster of cardiovascular risk factors is the rule, rather than the exception in hypertension. In addition, major cardiovascular diseases often develop from a subclinical level, which can be discovered at an early stage, thus providing the opportunity promptly to intercept and treat high-risk patients early. Identification of organ damage and assessment of hypertension-related clinical conditions can further contribute to a more precise definition of an individual total cardiovascular risk profile, and to the decision on when, how and how much to treat patients with hypertension. Implementing a clinical behaviour based on global cardiovascular risk assessment will help to target global cardiovascular risk reduction, while maintaining specific therapeutic goals for individual risk factors. This synergistic approach holds the best promise for treating total cardiovascular risk and reducing the mounting global burden of cardiovascular disease associated with hypertension. © 2009 Lippincott Williams & Wilkins, Inc.