1999 WHO/ISH HYPERTENSION GUIDELINES

Practice Guidelines for Primary Care Physicians.

Fill-in kindly the following form. After its completion you receive an automated assessment of a patient's cardiovascular risk and selecting drug treatment according to WHO/ISH guidelines.

Notice:

It is an auxiliary tool, a physician makes the concrete decision.

When the risk of cardiovascular disease (CVD) is assessed the unfilled items are considered as an answer "not known", however, as far as the risk stratification is concerned such an answer means "no".
In case of a low or medium risk it is essential to complete the majority of missing items, e.g. only those results of examinations, which are not performed without clinical suspicion can miss.
In case of selecting drug treatment of hypertension the unfilled items are also considered to be "no". When an additional contraindication is possible you will receive a notice.

Items marked: * are obligatory.

Patient's history and examinations
Patient Data and Risk Factors

First name:
Last name:
ID:

Gender:	*
Age:	*
Height:	cm
Weight:	kg

Yes No Unknown

High alcohol consumption: above 1/2 l of beer, 3 dcl of wine or 5cl of destilate daily

High salt consumption:

Low physical activity: less than 3 times weekly 30 minutes of sport activity

Smoking:

Family history of premature cardiovascular disease:

Diabetes mellitus:

Target Organ Damage (TOD)

Yes No Unknown
Left ventricular hypertrophy:

Proteinuria and/or slight elevation of plasma: (106 - 177 umol/l)

Evidence of atherosclerotic plaque:

Narrowing of the retinal arteries:

Associated Clinical Conditions (ACC)

Yes No Unknown
Ischaemic stroke:

Cerebral haemorrhage:

Transient ischaemic attack:

Myocardial infarction:

Angina pectoris:

Coronary revascularisation:

Congestive heart failure:

Diabetic nephropathy:

Renal failure:

Dissecting aneurysm:

Symptomatic arterial disease:

Retinal haemorrhages or exudates:

Retinal papilloedema:

Examinations

Blood pressure - systolic: mm Hg *

diastolic: mm Hg *

Total cholesterol: mmol/l *

LDL cholesterol: mmol/l

HDL cholesterol: mmol/l

Plasma creatinine concentration: umol/l *

	Yes	No	Unknown
High alcohol consumption:				above 1/2 l of beer, 3 dcl of wine or 5cl of destilate daily
High salt consumption:
Low physical activity:				less than 3 times weekly 30 minutes of sport activity
Smoking:
Family history of premature cardiovascular disease:
Diabetes mellitus:

	Yes	No	Unknown
Left ventricular hypertrophy:
Proteinuria and/or slight elevation of plasma:				(106 - 177 umol/l)
Evidence of atherosclerotic plaque:
Narrowing of the retinal arteries:

	Yes	No	Unknown
Ischaemic stroke:
Cerebral haemorrhage:
Transient ischaemic attack:
Myocardial infarction:
Angina pectoris:
Coronary revascularisation:
Congestive heart failure:
Diabetic nephropathy:
Renal failure:
Dissecting aneurysm:
Symptomatic arterial disease:
Retinal haemorrhages or exudates:
Retinal papilloedema:

Examinations
Blood pressure - systolic:	mm Hg *
diastolic:	mm Hg *
Total cholesterol:	mmol/l *
LDL cholesterol:	mmol/l
HDL cholesterol:	mmol/l
Plasma creatinine concentration:	umol/l *

Patient's history and examinations