Dataset Information

Incremental predictive value of adding past blood pressure measurements to the Framingham hypertension risk equation: the Whitehall II Study.

ABSTRACT: 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 performance: C statistics (0.796 versus 0.799), predicted:observed ratios (1.04 [95% CI: 0.95 to 1.15] versus 0.98 [95% CI: 0.89 to 1.08]), or Hosmer-Lemeshow chi(2) values (11.5 versus 6.5). The net reclassification improvement with the modified score was 9.3% (95% CI: 4.2% 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.

SUBMITTER: Kivimaki M

PROVIDER: S-EPMC2862166 | biostudies-literature | 2010 Apr

REPOSITORIES: biostudies-literature

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Incremental predictive value of adding past blood pressure measurements to the Framingham hypertension risk equation: the Whitehall II Study.

Kivimäki Mika M Tabak Adam G AG Batty G David GD Ferrie Jane E JE Nabi Hermann H Marmot Michael G MG Witte Daniel R DR Singh-Manoux Archana A Shipley Martin J MJ

Hypertension (Dallas, Tex. : 1979) 20100215 4

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 serva ...[more]

PMID: 20157053

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Project description:BackgroundPlatelet parameters during pregnancy were associated with the risk of preeclampsia (PE), but the predictive value of these parameters for PE remained unclear. Our aim was to clarify the individual and incremental predictive value of platelet parameters, including platelet count (PC), mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW) for PE.MethodsThis study was based on the Born in Guangzhou Cohort Study in China. Data on platelet parameters were extracted from medical records of routine prenatal examinations. Receiver operating characteristic (ROC) curve was performed to analyze the predictive ability of platelet parameters for PE. Maternal characteristic factors proposed by NICE and ACOG were used to develop the base model. Detection rate (DR), integrated discrimination improvement (IDI) and continuous net reclassification improvement (NRI) were calculated compared with the base model to assess the incremental predictive value of platelet parameters.ResultsA total of 30,401 pregnancies were included in this study, of which 376 (1.24%) were diagnosed with PE. Higher levels of PC and PCT were observed at 12-19 gestational weeks in women who developed PE later. However, no platelet parameters before 20 weeks of gestation reliably distinguished between PE complicated pregnancy and non-PE complicated pregnancy, with all values of the areas under the ROC curves (AUC) below 0.70. The addition of platelet parameters at 16-19 gestational weeks to the base model increased the DR for preterm PE from 22.9 to 31.4% at a fixed false positive rate of 5%, improved the AUC from 0.775 to 0.849 (p = 0.015), and yielded a NRI of 0.793 (p < 0.001), and an IDI of 0.0069 (p = 0.035). Less but significant improvement in prediction performance was also observed for term PE and total PE when all the four platelet parameters were added to the base model.ConclusionsAlthough no single platelet parameter at the early stage of pregnancy identified PE with high accuracy, the addition of platelet parameters to known independent risk factors could improve the prediction of PE.

Project description:OBJECTIVES:We sought to determine whether screening for anxiety and depression, an emerging risk factor for type 2 diabetes (T2D), adds clinically meaningful information beyond current T2D risk assessment tools. DESIGN:Prospective cohort. PARTICIPANTS AND SETTING:The 45 and Up Study is a large-scale prospective cohort of men and women aged 45 years and over, randomly sampled from the general population of New South Wales, Australia. 51 588 participants without self-reported diabetes at baseline (2006-2009) were followed up for approximately 3 years (2010). METHODS:T2D status was determined by self-reported doctor who diagnosed diabetes after the age of 30 years, and/or current use of metformin. Current symptoms of anxiety and/or depression were measured by the 10-item Kessler Psychological Distress Scale (K10). We determined the optimal cut-off point for K10 for predicting T2D using Tjur's R2 and tested risk models with and without the K10 using logistic regression. We assessed performance measures for the incremental value of the K10 using the area under the receiver operating characteristic (AROC), net reclassification improvement (NRI) and net benefit (NB) decision analytics with sensitivity analyses. RESULTS:T2D developed in 1076 individuals (52.4% men). A K10 score of ?19 (prevalence 8.97%), adjusted for age and gender, was optimal for predicting incident T2D (sensitivity 77%, specificity 53% and positive predictive value 3%; OR 1.70 (95% CI 1.41 to 2.03, P<0.001). K10 score predicted incident T2D independent of current risk models, but did not improve corresponding AROC, NRI and NB statistics. Sensitivity analyses showed that this was partially explained by the baseline model and the small effect size of the K10 that was similar compared with other risk factors. CONCLUSIONS:Anxiety and depressing screening with the K10 adds no meaningful incremental value in addition to current T2D risk assessments. The clinical importance of anxiety and depression screening in preventing T2D requires ongoing consideration.

Dataset Information

Incremental predictive value of adding past blood pressure measurements to the Framingham hypertension risk equation: the Whitehall II Study.

Publications

Incremental predictive value of adding past blood pressure measurements to the Framingham hypertension risk equation: the Whitehall II Study.

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