title: Comparison of the Framingham Heart Study hypertension model with blood pressure alone in the prediction of risk of hypertension: the Multi-Ethnic Study of Atherosclerosis.
abstract: A prediction model, developed in the Framingham Heart Study (FHS), has been proposed for use in estimating a given individual's risk of hypertension. We compared this model with systolic blood pressure (SBP) alone and age-specific diastolic blood pressure categories for the prediction of hypertension. Participants in the Multi-Ethnic Study of Atherosclerosis, without hypertension or diabetes mellitus (n=3013), were followed for the incidence of hypertension (SBP > or =140 mm Hg and/or diastolic blood pressure > or =90 mm Hg and/or the initiation of antihypertensive medication). The predicted probability of developing hypertension among 4 adjacent study examinations, with a median of 1.6 years between examinations, was determined. The mean (SD) age of participants was 58.5 (9.7) years, and 53% were women. During follow-up, 849 incident cases of hypertension occurred. The c statistic for the FHS model was 0.788 (95% CI: 0.773 to 0.804) compared with 0.768 (95% CI: 0.751 to 0.785; P=0.096 compared with the FHS model) for SBP alone and 0.699 (95% CI: 0.681 to 0.717; P<0.001 compared with the FHS model) for age-specific diastolic blood pressure categories. The relative integrated discrimination improvement index for the FHS model versus SBP alone was 10.0% (95% CI: -1.7% to 22.7%) and versus age-specific diastolic blood pressure categories was 146.0% (95% CI: 116.0% to 181.0%). Using the FHS model, there were significant differences between observed and predicted hypertension risks (Hosmer-Lemeshow goodness of fit: P<0.001); recalibrated and best-fit models produced a better model fit (P=0.064 and 0.245, respectively). In this multiethnic cohort of US adults, the FHS model was not substantially better than SBP alone for predicting hypertension.
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA. pmuntner@uab.edu
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: Devin M
authors.initials: DM
authors.lastname: Mann
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
authors.forename: Erin D
authors.initials: ED
authors.lastname: Michos
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.forename: April P
authors.initials: AP
authors.lastname: Carson
authors.forename: Haiying
authors.initials: H
authors.lastname: Chen
authors.forename: Donna K
authors.initials: DK
authors.lastname: Arnett
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination; D015331:Cohort Studies; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology*; D003971:Diastole / Q000502:physiology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology*; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D011237:Predictive Value of Tests; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013599:Systole / Q000502:physiology
chemical_list: D000959:Antihypertensive Agents