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Figure 11 2 British Hypertension Society algorithm for diagnosis and treatment of hypertension, incorporating total cardiovascular risk in deciding which prehypertensive patients to treat (CVD, cardiovascular disease) (Reproduced, with permission, from: Guidelines for management of hypertension: report of the Fourth Working Party of the British Hypertension Society, 2004-BHS IV J Hum Hypertens 2004;18:139 185)

thereby placing the emphasis on the prevention of catastrophic events in advanced disease More recently, in parallel with a new emphasis on hypertension in the context of overall cardiovascular risk, attention is turning to the importance of the long view Accordingly, treatment of persons with hypertension should focus on comprehensive risk reduction More careful consideration should be given to the possible long-term adverse consequences of the metabolic derangements linked to some antihypertensives (particularly conventional -blockers and thiazide diuretics) Statins should be more widely used In this respect, there is now evidence from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) that statins can significantly improve outcomes in persons with hypertension (with modest background cardiovascular risk) whose total cholesterol is < 250 mg/dL Furthermore, this effect appeared to be synergistic with calcium channel blocker/ACE inhibitor regimens but not -blocker/diuretic regimens The BHS guidelines recommend that statins be offered as secondary prevention to patients whose total cholesterol exceeds 135 mg/dL if they have documented coronary artery disease or a history of

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ischemic stroke In addition, statins should be considered as primary prevention in patients with long-standing type 2 diabetes mellitus or in those with type 2 diabetes mellitus who are older than age 50 years, and perhaps in all persons with type 2 diabetes mellitus Ideally, total and low-density lipoprotein (LDL) cholesterol should be reduced by 30% and 40% respectively, or to approximately < 155 mg/dL and < 77 mg/dL, whichever is the greatest reduction However, total and LDL cholesterol levels of < 194 mg/dL and < 116 mg/dL respectively, or reductions of 25% and 30% are regarded as clinically acceptable objectives Primary prevention with statins might also be reasonably extended to all patients with total cholesterol > 135 mg/dL and a total cardiovascular risk > 20% (to similar target cholesterol levels), but trial evidence for this is not currently available Low-dose aspirin (81 mg/day) is likely to be beneficial in patients older than age 50 with either target organ damage or elevated total cardiovascular risk (> 20 30%) Care should be taken to ensure that blood pressure is controlled to the recommended levels in patients receiving aspirin to minimize the risk of bleeding

Major risk factors Hypertension1 Cigarette smoking Obesity (BMI 30)1 Physical inactivity Dyslipidemia1 Diabetes mellitus1 Microalbuminuria or estimated GFR < 60 mL/min Age (> 55 years for men, > 65 years for women) Family history of premature cardiovascular disease (men < 55 years or women < 65 years) Target-organ damage Heart Left ventricular hypertrophy Angina or prior myocardial infarction Prior coronary revascularization Heart failure Brain Stroke or transient ischemic attack Chronic kidney disease Peripheral arterial disease Retinopathy Components of the metabolic syndrome BMI indicates body mass index calculated as weight in kilograms divided by the square of height in meters; GFR, glomerular filtration rate Reprinted, with permission, from Chobanian AV et al The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report JAMA 2003 May 21; 289(19):2560 72

The contract data allowed field is a critical field used by the system in contracts As contract data, for example, validity periods and cancellation data may be kept at the header level as well as at the item level of the contract This field indicates to the system what to do when data differs between the header and item levels With the setting as an X, the system will not copy any changes you make in the header level into the item levels This is also true even if the data at header and line item were identical prior to the header data being changed With the setting as Y, the system automatically copies all header data into the item in the contract (only if the header and item contract data were identical prior to the changes) The follow-up activity type is used to speed up the creation of follow-up activities For example, the follow-up sales activity type 0002 (telephone call) is specified for sales document type WV (service contract) You create a follow-up activity work list for contracts in Sales Support (CAS) and maintain the selection criteria as required This is maintained in the following menu path

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