A risk score for predicting near-term incidence of hypertension: the Framingham Heart Study.
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.


METHODS
Longitudinal cohort study.


METHODS
Framingham Heart Study, Framingham, Massachusetts.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.


CONCLUSIONS
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.
Parikh
Nisha I
NI
Framingham Heart Study, Framingham, Massachusetts 01702-5803, USA.
Pencina
Michael J
MJ
Wang
Thomas J
TJ
Benjamin
Emelia J
EJ
Lanier
Katherine J
KJ
Levy
Daniel
D
D'Agostino
Ralph B
RB
Kannel
William B
WB
Vasan
Ramachandran S
RS
D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000235:genetics; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010290:Parents; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects