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Incremental Predictive Value of Adding Past Blood Pressure Measurements to the Framingham Hypertension Risk Equation: The Whitehall II Study

Records of repeated examinations of blood pressure are increasingly available for primary care patients, but the use of this information in predicting incident hypertension remains unclear, because cohort studies with repeat blood pressure monitoring are rare. We compared the incremental value of us... Full description

Journal Title: Hypertension (Dallas Tex. 1979), 2010-04, Vol.55 (4), p.1058-1062
Main Author: Kivimäki, Mika
Other Authors: Tabak, Adam G , Batty, G David , Ferrie, Jane E , Nabi, Hermann , Marmot, Michael G , Witte, Daniel R , Singh-Manoux, Archana , Shipley, Martin J
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: Hagerstown, MD: American Heart Association, Inc
ID: ISSN: 0194-911X
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recordid: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_2862166
title: Incremental Predictive Value of Adding Past Blood Pressure Measurements to the Framingham Hypertension Risk Equation: The Whitehall II Study
format: Article
creator:
  • Kivimäki, Mika
  • Tabak, Adam G
  • Batty, G David
  • Ferrie, Jane E
  • Nabi, Hermann
  • Marmot, Michael G
  • Witte, Daniel R
  • Singh-Manoux, Archana
  • Shipley, Martin J
subjects:
  • Adult
  • Aged
  • Algorithms
  • Arterial hypertension. Arterial hypotension
  • Article
  • Biological and medical sciences
  • Blood and lymphatic vessels
  • Blood Pressure - physiology
  • Blood Pressure Determination
  • Cardiology. Vascular system
  • Chi-Square Distribution
  • Clinical manifestations. Epidemiology. Investigative techniques. Etiology
  • Female
  • Health Surveys
  • Humans
  • Hypertension
  • Hypertension - epidemiology
  • Hypertension - physiopathology
  • Incidence
  • Life Sciences
  • Male
  • Medical sciences
  • Middle Aged
  • Models, Cardiovascular
  • prevention
  • primary prevention
  • public health
  • Risk Assessment
  • Risk Factors
  • Santé publique et épidémiologie
ispartof: Hypertension (Dallas, Tex. 1979), 2010-04, Vol.55 (4), p.1058-1062
description: Records of repeated examinations of blood pressure are increasingly available for primary care patients, but the use of this information in predicting incident hypertension remains unclear, because cohort studies with repeat blood pressure monitoring are rare. We compared the incremental value of using data on blood pressure history to a single measure as in the Framingham hypertension risk score, a validated hypertension risk prediction algorithm. Participants were 4314 London-based civil servants (1297 women) aged 35 to 68 years who were free from prevalent hypertension, diabetes mellitus, and coronary heart disease at baseline examination (the Whitehall II Study). Standard clinical examinations of blood pressure, weight and height, current cigarette smoking, and parental history of hypertension were undertaken on a 5-year basis. A total of 1052 incident (new-onset) cases of hypertension were observed in two 5-year baseline follow-up data cycles. Comparison of the Framingham risk score with a score additionally incorporating 5-year blood pressure history showed, at best, modest improvements in indicators of predictive performanceC statistics (0.796 versus 0.799), predicted:observed ratios (1.04 [95% CI0.95 to 1.15] versus 0.98 [95% CI0.89 to 1.08]), or Hosmer-Lemeshow χ values (11.5 versus 6.5). The net reclassification improvement with the modified score was 9.3% (95% CI4.2% to 14.4%), resulting from a net 17.1% increase in nonhypertensives correctly identified as being at lower risk but a net 7.8% increase in hypertensives incorrectly identified as at lower risk. These data suggest that, despite the net reclassification improvement, the clinical use of adding repeat measures of blood pressure to the Framingham hypertension risk score may be limited.
language: eng
source:
identifier: ISSN: 0194-911X
fulltext: no_fulltext
issn:
  • 0194-911X
  • 1524-4563
url: Link


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titleIncremental Predictive Value of Adding Past Blood Pressure Measurements to the Framingham Hypertension Risk Equation: The Whitehall II Study
creatorKivimäki, Mika ; Tabak, Adam G ; Batty, G David ; Ferrie, Jane E ; Nabi, Hermann ; Marmot, Michael G ; Witte, Daniel R ; Singh-Manoux, Archana ; Shipley, Martin J
creatorcontribKivimäki, Mika ; Tabak, Adam G ; Batty, G David ; Ferrie, Jane E ; Nabi, Hermann ; Marmot, Michael G ; Witte, Daniel R ; Singh-Manoux, Archana ; Shipley, Martin J
descriptionRecords of repeated examinations of blood pressure are increasingly available for primary care patients, but the use of this information in predicting incident hypertension remains unclear, because cohort studies with repeat blood pressure monitoring are rare. We compared the incremental value of using data on blood pressure history to a single measure as in the Framingham hypertension risk score, a validated hypertension risk prediction algorithm. Participants were 4314 London-based civil servants (1297 women) aged 35 to 68 years who were free from prevalent hypertension, diabetes mellitus, and coronary heart disease at baseline examination (the Whitehall II Study). Standard clinical examinations of blood pressure, weight and height, current cigarette smoking, and parental history of hypertension were undertaken on a 5-year basis. A total of 1052 incident (new-onset) cases of hypertension were observed in two 5-year baseline follow-up data cycles. Comparison of the Framingham risk score with a score additionally incorporating 5-year blood pressure history showed, at best, modest improvements in indicators of predictive performanceC statistics (0.796 versus 0.799), predicted:observed ratios (1.04 [95% CI0.95 to 1.15] versus 0.98 [95% CI0.89 to 1.08]), or Hosmer-Lemeshow χ values (11.5 versus 6.5). The net reclassification improvement with the modified score was 9.3% (95% CI4.2% to 14.4%), resulting from a net 17.1% increase in nonhypertensives correctly identified as being at lower risk but a net 7.8% increase in hypertensives incorrectly identified as at lower risk. These data suggest that, despite the net reclassification improvement, the clinical use of adding repeat measures of blood pressure to the Framingham hypertension risk score may be limited.
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subjectAdult ; Aged ; Algorithms ; Arterial hypertension. Arterial hypotension ; Article ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Pressure - physiology ; Blood Pressure Determination ; Cardiology. Vascular system ; Chi-Square Distribution ; Clinical manifestations. Epidemiology. Investigative techniques. Etiology ; Female ; Health Surveys ; Humans ; Hypertension ; Hypertension - epidemiology ; Hypertension - physiopathology ; Incidence ; Life Sciences ; Male ; Medical sciences ; Middle Aged ; Models, Cardiovascular ; prevention ; primary prevention ; public health ; Risk Assessment ; Risk Factors ; Santé publique et épidémiologie
ispartofHypertension (Dallas, Tex. 1979), 2010-04, Vol.55 (4), p.1058-1062
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1Tabak, Adam G
2Batty, G David
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descriptionRecords of repeated examinations of blood pressure are increasingly available for primary care patients, but the use of this information in predicting incident hypertension remains unclear, because cohort studies with repeat blood pressure monitoring are rare. We compared the incremental value of using data on blood pressure history to a single measure as in the Framingham hypertension risk score, a validated hypertension risk prediction algorithm. Participants were 4314 London-based civil servants (1297 women) aged 35 to 68 years who were free from prevalent hypertension, diabetes mellitus, and coronary heart disease at baseline examination (the Whitehall II Study). Standard clinical examinations of blood pressure, weight and height, current cigarette smoking, and parental history of hypertension were undertaken on a 5-year basis. A total of 1052 incident (new-onset) cases of hypertension were observed in two 5-year baseline follow-up data cycles. Comparison of the Framingham risk score with a score additionally incorporating 5-year blood pressure history showed, at best, modest improvements in indicators of predictive performanceC statistics (0.796 versus 0.799), predicted:observed ratios (1.04 [95% CI0.95 to 1.15] versus 0.98 [95% CI0.89 to 1.08]), or Hosmer-Lemeshow χ values (11.5 versus 6.5). The net reclassification improvement with the modified score was 9.3% (95% CI4.2% to 14.4%), resulting from a net 17.1% increase in nonhypertensives correctly identified as being at lower risk but a net 7.8% increase in hypertensives incorrectly identified as at lower risk. These data suggest that, despite the net reclassification improvement, the clinical use of adding repeat measures of blood pressure to the Framingham hypertension risk score may be limited.
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titleIncremental Predictive Value of Adding Past Blood Pressure Measurements to the Framingham Hypertension Risk Equation: The Whitehall II Study
authorKivimäki, Mika ; Tabak, Adam G ; Batty, G David ; Ferrie, Jane E ; Nabi, Hermann ; Marmot, Michael G ; Witte, Daniel R ; Singh-Manoux, Archana ; Shipley, Martin J
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abstractRecords of repeated examinations of blood pressure are increasingly available for primary care patients, but the use of this information in predicting incident hypertension remains unclear, because cohort studies with repeat blood pressure monitoring are rare. We compared the incremental value of using data on blood pressure history to a single measure as in the Framingham hypertension risk score, a validated hypertension risk prediction algorithm. Participants were 4314 London-based civil servants (1297 women) aged 35 to 68 years who were free from prevalent hypertension, diabetes mellitus, and coronary heart disease at baseline examination (the Whitehall II Study). Standard clinical examinations of blood pressure, weight and height, current cigarette smoking, and parental history of hypertension were undertaken on a 5-year basis. A total of 1052 incident (new-onset) cases of hypertension were observed in two 5-year baseline follow-up data cycles. Comparison of the Framingham risk score with a score additionally incorporating 5-year blood pressure history showed, at best, modest improvements in indicators of predictive performanceC statistics (0.796 versus 0.799), predicted:observed ratios (1.04 [95% CI0.95 to 1.15] versus 0.98 [95% CI0.89 to 1.08]), or Hosmer-Lemeshow χ values (11.5 versus 6.5). The net reclassification improvement with the modified score was 9.3% (95% CI4.2% to 14.4%), resulting from a net 17.1% increase in nonhypertensives correctly identified as being at lower risk but a net 7.8% increase in hypertensives incorrectly identified as at lower risk. These data suggest that, despite the net reclassification improvement, the clinical use of adding repeat measures of blood pressure to the Framingham hypertension risk score may be limited.
copHagerstown, MD
pubAmerican Heart Association, Inc
pmid20157053
doi10.1161/HYPERTENSIONAHA.109.144220
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