Cardiovascular diseases are the leading cause of death in the world, and still increasing due to changing life habits and ageing population.

The Harmonica Project was created to identify 45–70-year-old persons at risk for cardiovascular diseases in the general population. Using two-stage screening method we could target the nurse-given lifestyle counselling to risk persons, and limit the number of physician’s appointments for those who might benefit from preventive medication. Finnish Diabetes Risk Score and nurse-measured blood pressure were practical primary screening methods in the general population. The expertise of nurses could be utilized more in primary care to identify the high risk subjects in communities.

Among the 4 450 participants of the Harmonica project in Harjavalta and Kokemäki, a total of 1 106 subjects with hypertension were identified, when patients with known cardiovascular disease and previously diagnosed diabetes were excluded. In this way, the impact of hypertension <i>per se</i> on glucose homeostasis and target organ damage could be estimated.

Glucose disorders are more common in hypertensive subjects than in the general population. Using the criteria of the metabolic syndrome as the criteria for performing an oral glucose tolerance test, the number of tests can be reduced by one third and still find almost all the cases of type 2 diabetes and prediabetes.

Moderately decreased renal function is as common as newly detected diabetes in hypertensive subjects. Especially hypertensive women with the metabolic syndrome are at risk for renal insufficiency. If renal function of the hypertensive subjects is estimated by plasma creatinine alone, three-fourth of the patients with renal insufficiency would be overlooked compared to using estimated glomerular filtration rate as the screening method.

Peripheral arterial disease or borderline peripheral arterial disease can be detected in every third of the hypertensive subjects, more often in those with widened pulse pressure over 65 mmHg. Hypertension is an independent risk factor associated with peripheral arterial disease. Measuring ankle-brachial index using the lower of either one of the ankle pressures might be practical in primary care practice to identify the persons at high cardiovascular risk.

Commonly used cardiovascular risk stratification methods, or the novel risk factor high-sensitivity C-reactive protein, can not replace the estimation of subclinical target organ damage in assessing the total cardiovascular risk of hypertensive subjects.