Comparison of the Framingham Heart Study hypertension model with blood pressure alone in the prediction of risk of hypertension: the Multi-Ethnic Study of Atherosclerosis.

Academic Article

Abstract

  • A prediction model, developed in the Framingham Heart Study (FHS), has been proposed for use in estimating a given individual's risk of hypertension. We compared this model with systolic blood pressure (SBP) alone and age-specific diastolic blood pressure categories for the prediction of hypertension. Participants in the Multi-Ethnic Study of Atherosclerosis, without hypertension or diabetes mellitus (n=3013), were followed for the incidence of hypertension (SBP > or =140 mm Hg and/or diastolic blood pressure > or =90 mm Hg and/or the initiation of antihypertensive medication). The predicted probability of developing hypertension among 4 adjacent study examinations, with a median of 1.6 years between examinations, was determined. The mean (SD) age of participants was 58.5 (9.7) years, and 53% were women. During follow-up, 849 incident cases of hypertension occurred. The c statistic for the FHS model was 0.788 (95% CI: 0.773 to 0.804) compared with 0.768 (95% CI: 0.751 to 0.785; P=0.096 compared with the FHS model) for SBP alone and 0.699 (95% CI: 0.681 to 0.717; P<0.001 compared with the FHS model) for age-specific diastolic blood pressure categories. The relative integrated discrimination improvement index for the FHS model versus SBP alone was 10.0% (95% CI: -1.7% to 22.7%) and versus age-specific diastolic blood pressure categories was 146.0% (95% CI: 116.0% to 181.0%). Using the FHS model, there were significant differences between observed and predicted hypertension risks (Hosmer-Lemeshow goodness of fit: P<0.001); recalibrated and best-fit models produced a better model fit (P=0.064 and 0.245, respectively). In this multiethnic cohort of US adults, the FHS model was not substantially better than SBP alone for predicting hypertension.
  • Published In

  • Hypertension  Journal
  • Keywords

  • Age Distribution, Aged, Aged, 80 and over, Antihypertensive Agents, Blood Pressure Determination, Cohort Studies, Confidence Intervals, Coronary Artery Disease, Diastole, Ethnic Groups, Female, Follow-Up Studies, Humans, Hypertension, Incidence, Linear Models, Male, Middle Aged, Models, Cardiovascular, Predictive Value of Tests, Probability, Risk Assessment, Severity of Illness Index, Sex Distribution, Systole
  • Digital Object Identifier (doi)

    Pubmed Id

  • 8982144
  • Author List

  • Muntner P; Woodward M; Mann DM; Shimbo D; Michos ED; Blumenthal RS; Carson AP; Chen H; Arnett DK
  • Start Page

  • 1339
  • End Page

  • 1345
  • Volume

  • 55
  • Issue

  • 6