A Risk Score for Predicting Near-Term Incidence of Hypertension: The Framingham Heart Study

  1. Nisha I. Parikh, MD, MPH;
  2. Michael J. Pencina, PhD;
  3. Thomas J. Wang, MD;
  4. Emelia J. Benjamin, MD, ScM;
  5. Katherine J. Lanier, BS;
  6. Daniel Levy, MD;
  7. Ralph B. D'Agostino, Sr, PhD;
  8. William B. Kannel, MD; and
  9. Ramachandran S. Vasan, MD
  1. From the Framingham Heart Study, Framingham, Massachusetts; Massachusetts General Hospital, Boston University, and Boston University School of Medicine, Boston, Massachusetts; and National Heart, Lung, and Blood Institute, Bethesda, Maryland.

    Abstract

    Background: Studies suggest that targeting high-risk, nonhypertensive individuals for treatment may delay hypertension onset, thereby possibly mitigating vascular complications. Risk stratification may facilitate cost-effective approaches to management.

    Objective: To develop a simple risk score for predicting hypertension incidence by using measures readily obtained in the physician's office.

    Design: Longitudinal cohort study.

    Setting: Framingham Heart Study, Framingham, Massachusetts.

    Patients: 1717 nonhypertensive white individuals 20 to 69 years of age (mean age, 42 years; 54% women), without diabetes and with both parents in the original cohort of the Framingham Heart Study, contributed 5814 person-examinations.

    Measurements: Scores were developed for predicting the 1-, 2-, and 4-year risk for new-onset hypertension, and performance characteristics of the prediction algorithm were assessed by using calibration and discrimination measures. Parental hypertension was ascertained from examinations of the original cohort of the Framingham Heart Study.

    Results: During follow-up (median time over all person-examinations, 3.8 years), 796 persons (52% women) developed new-onset hypertension. In multivariable analyses, age, sex, systolic and diastolic blood pressure, body mass index, parental hypertension, and cigarette smoking were significant predictors of hypertension. According to the risk score based on these factors, the 4-year risk for incident hypertension was classified as low (<5%) in 34% of participants, medium (5% to 10%) in 19%, and high (>10%) in 47%. The c-statistic for the prediction model was 0.788, and calibration was very good.

    Limitations: The risk score findings may not be generalizable to persons of nonwhite race or ethnicity or to persons with diabetes. The risk score algorithm has not been validated in an independent cohort and is based on single measurements of risk factors and blood pressure.

    Conclusion: The hypertension risk prediction score can be used to estimate an individual's absolute risk for hypertension on short-term follow-up, and it represents a simple, office-based tool that may facilitate management of high-risk individuals with prehypertension.

    Article and Author Information

    • Grant Support: By National Heart, Lung, and Blood Institute contracts N01-HC-25195 and K23-HL074077-01 (Dr. Wang) and 2K24HL04334 (Dr. Vasan).

    • Potential Financial Conflicts of Interest:Other: T.J. Wang (Novartis Institutes for Biomedical Research).

    • Requests for Single Reprints: Ramachandran S. Vasan, MD, Framingham Heart Study, 73 Mount Wayte Avenue, Suite 2, Framingham, MA 01702-5803; e-mail, vasan{at}bu.edu.

    • Current Author Addresses: Dr. Parikh: Cardiovascular Division, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, West Baker 4, Boston, MA 02215.

    • Drs. Pencina and D'Agostino and Ms. Lanier: Department of Mathematics and Statistics, Department of Biostatistics, Boston University, 111 Cummington Street, Boston, MA 02215.

    • Dr. Wang: Cardiology Division, GRB-800, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.

    • Drs. Benjamin, Levy, Kannel, and Vasan: Framingham Heart Study, 73 Mount Wayte Avenue, Suite 2, Framingham, MA 01702-5803.

    • Author Contributions: Conception and design: N.I. Parikh, M.J. Pencina, T.J. Wang, R.B. D'Agostino Sr., R.S. Vasan.

    • Analysis and interpretation of the data: N.I. Parikh, M.J. Pencina, K.J. Lanier, D. Levy, R.B. D'Agostino Sr., R.S. Vasan.

    • Drafting of the article: N.I. Parikh, M.J. Pencina, R.S. Vasan.

    • Critical revision of the article for important intellectual content: N.I. Parikh, M.J. Pencina, T.J. Wang, E.J. Benjamin, D. Levy, R.B. D'Agostino Sr., W.B. Kannel, R.S. Vasan.

    • Final approval of the article: N.I. Parikh, M.J. Pencina, T.J. Wang, E.J. Benjamin, R.B. D'Agostino Sr., W.B. Kannel, R.S. Vasan.

    • Statistical expertise: M.J. Pencina, R.B. D'Agostino Sr.,

    • Obtaining of funding: R.B. D'Agostino Sr., R.S. Vasan.

    • Administrative, technical or logistic support: R.S. Vasan.

    • Collection and assembly of data: N.I. Parikh, K.J. Lanier, D. Levy.

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