Background

 Hypertension is the leading global contributor to premature death and disability.

Systolic Blood Pressure (SBP) ≥140 mmHg accounts for most (± 70%) of the
mortality and disability burden, and the largest number of SBP-related
deaths/year are due to ischemic heart disease (4,9 million), hemorrhagic stroke (2,0
million), and ischemic stroke (1,5 million).
 Daha Sejahtera Hospital is located at wetland area- where water covers the soil, or is
present either at or near the surface of the soil all year or for varying periods of
time during the year, including during the growing season. Daha Sejahtera
Hospital has been running the hypertension clinic because the hypertension
epidemiology was quitely high in this area.
 Recommendation on the prevention of cardiovascular events – fatal or non fatal – in
clinical practice stress the need of procedure that beneficial, useful, and effective.
The SCORE System is a necessity for clinician in clinic or hospital for use in
management of a person with CV risk in clinical practice.

 
Objective
This study will investigate the implementation of evidence based procedure for high
quality medical care/practice to improve performance and to describe a team and
system approach (practice based system) for managing outpatients with hypertension with
SCORE System.

 
Materials and Methods
This was observational study. The subjects were 31 hypertension patient who didn’t have
cardiovascular events, the subjects was choosen randomizely. Hypertension guideline by
ESH was used for diagnosed the hypertension. We used two types of
sphygmomanometer, the mercury (Riester mercury sphygmomanometer) and aneroid
(ABN aneroid sphygmomanometer. The Blood pressure was measured according to the
ESH’s procedure. Beside the blood pressure, history of smoking and cholesterol level was
needed in SCORE. The cholesterol level was examined with Biosystem Chemistry
Analyzer A15, before the examination the sample was instructed to fasting 8 hours
minimal. All the collected data was put into the table and converted with SCORE system.

No Age Gender Smoking SBP (mm

1 65 Woman No 164
2 39 Woman No 160

3 46 Woman No 190

4 35 Woman No 150

5 44 Woman No 180

6 60 Man No 170

7 42 Woman No 130

8 57 Woman No 130

9 65 Woman No 150

10 57 Man No 150

11 66 Woman Yes 145

12 63 Woman No 140

13 54 Woman No 180

14 51 Woman No 150

15 66 Woman No 160

16 51 Woman No 170

17 40 Man Yes 130

18 41 Man Yes 180

19 63 Man No 140

20 51 Woman No 140

21 72 Man No 160

22 73 Man Yes 170

 23 65 Man No 140

24 43 Woman No 170

25 52 Woman No 170

26 55 Man Yes 140

27 46 Woman No 140

28 57 Woman No 140

29 60 Man Yes 145

30 44 Woman No 180

31 64 Woman No 160

Thirty-one patients (10 men and 21 women) was diagnosed with hypertension. Six
patients were smoker (16%). The distribution of systolic blood pressure (categorized
according to hypertension grading) : 17 patients with grade 1 HTN (54%) , 5 patients
with grade 2 HTN (16%) , 6 patients with grade 3 HTN (19%) and 3 patients with high
normal (11%). Total Cholesterol level distribution : 11 patients were < 6 mmol/L (35%)
and 20 patients were ≥ 6 mmol/L (65%). The SCORE system classified the patient
CV risk into 13 patients with low risk (41%), 5 patients with moderate risk (16%), 8
patients with high risk (23%) and 5 patients with very high risk (16%).
 Discussion
All current guidelines on the prevention of CVD in clinical practice recommend the
assessment of total CVD risk since atherosclerosis is usually the product of a number of
risk factors. It is essential for clinicians to be able to assess CV risk rapidly and with
sufficient accuracy. Many CV risk assessment systems are available and most project 10
year risk. The SCORE charts have been developed to estimate risk in both high and low-
risk populations. Since 2003, the European Guidelines on CVD prevention have
recommended use of the Systematic Coronary Risk Evaluation (SCORE) system
because it is based on large, representative European cohort data sets. In ESH guideline
2018 has stated that CV risk assessment with the SCORE system is recommended for
hypertensive patients who are not already at high or very high risk due to established
CVD, renal disease, or diabetes, a markedly elevaated single risk factor (e.g. cholesterol),
or hypertensive LVH (level of evidence 1B).
 
Modifiable risk factors such as smoking and high lipid profiles have an impact on the
increased risk of CVD. Smoking enhances the development of both atherosclerosis and
superimposed thrombotic phenomena. Plaque formation is not thought to be fully
reversible and thus smokers would never be expected to reach the risk level of never
smokers concerning CVD. Besides elevated levels of plasma LDL-C are causal to
atherosclerosis. Reduction of LDL-C decreases CV events. Low HDL-C is associated
with increased CV risk, but manoeuvres to increase HDL-C have not been associated
with a decreased CV risk. Meta-analyses of many statin trials show a dose-dependent
relative reduction in CVD with LDL-C lowering. Every 1.0 mmol/L reduction in LDL-C
is associated with a corresponding 20–25% reduction in CVD mortality and non-fatal
MI.
 Conclusion
Cardiovascular risk assessment has been carried out in the sub-district population of
Daha by SCORE system. The SCORE estimation system offers direct estimation of
cardiovascular risk in a format suited to the constraints of clinical practice.
References
1. Massimo F. Piepoli, Arno W. Hoes, Stefan Agewall. European Guidelines on
cardiovascular disease prevention in clinical practice. 2016;37:2315–2381
2. Bryan Williams, Giuseppe Mancia, Wilko Spiering, et al. 2018 ESC/ESH Guidelines
for the management of arterial hypertension. 2018:1-98.
3. R.M. Conroy K. Pyörälä A.P. Fitzgerald, et al. Estimation of ten-year risk of fatal
cardiovascular disease in Europe: the SCORE project. European Heart Journal.
2003;24:987–1003.
 

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