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: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.

Project description:Right ventricular function has been identified as an important prognostic factor in children with pulmonary arterial hypertension. The aim of the study was to assess the deformation pattern and prognostic value of right ventricular longitudinal strain in children with pulmonary arterial hypertension.We prospectively evaluated 46 children (25 with pulmonary arterial hyperetension and 21 age and sex matched controls) using conventional and speckle-tracking echocardiography, brain natriuretic peptide levels and clinical status expressed by WHO functional class and 6-min walking test. According to the clinical status after 12 months of follow-up, the pulmonary arterial hypertension patients were divided in two groups: non-worsening (13) and worsening (12).Right ventricular free wall longitudinal strain and strain rate were significantly lower in children with PAH compared with controls (-24.72 ± 3.48 vs -15.60 ± 3.40, p = 0.0001 and -1.44 ± 0.09 vs -1.09 ± 0.15, p = 0.0001, respectively). There was a more expressed decrease of basal than apical region of right ventricular free wall longitudinal strain/strain rate in pulmonary arterial hypertension patients compared with controls (strain: p = 0.0001 vs p = 0.07 and strain rate: p = 0.0001 vs p = 0.002). Comparing worsening and non-worsening pulmonary arterial hypertension patients there was a significant difference in Mid right ventricular free wall longitudinal strain (-14.00 ± 3.13 vs. -20.76 ± 4.62, p = 0.0001). In multivariable logistic regression analysis Mid right ventricular free wall longitudinal strain was an independent predictor of worsening in pulmonary arterial hypertension children (OR 0.45; 95 % CI: 0.21-0.96, p = 0.041). In ROC curve analysis a cut-off value of Mid right ventricular free wall longitudinal strain of -18.50 % predicted clinical worsening in pulmonary arterial hypertension children, with a sensitivity and specificity of 91.7 and 30.8 %, respectively (area under curve = 0.88 ± 0.06, 95 % CI: 0.75-1.00, p = 0.001).Two-dimensional speckle-tracking echocardiography is a complementary non-invasive tool for assessment of right ventricular function in children with severe pulmonary arterial hypertension, allowing also clinical prediction and segmental analysis of right ventricular myocardial performance in these patients.

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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