A score for the prediction of cardiovascular events in the hypertensive aged.
BACKGROUND
With few exceptions, tools used to estimate cardiovascular disease (CVD) risk in those without prior events are based mainly on data from middle-aged subjects. Given the ever increasing number of older people, many with hypertension, a risk score relevant to this group is warranted. Our aim was to develop a cardiovascular risk equation suitable for risk prediction in elderly, hypertensive populations.


METHODS
We utilized cardiovascular end point data from 4.1 years median follow-up in 5,426 hypertensive subjects without previous CVD from the Second Australian National Blood Pressure Study (ANBP2). Our risk model, based on Cox regression, was developed using 75% of subjects without evident CVD (n = 4,072), randomly selected and stratified by age and gender, and internally validated using the remaining 25%. The model was also externally validated against the Dubbo Study dataset.


RESULTS
The final model included sex, age, physical activity in the 2 weeks prior to entry into study, family history, use of anticoagulants, centrally acting antihypertensive agents or diabetes medication, and an interaction term for sex and diabetes medication. The C-statistic was 0.65 (0.62-0.67) for our predictive model on the model development dataset and 0.62 (0.57-0.67) on the internal validation dataset. The Dubbo Data C-statistic for CVD was 0.68 (95% CI 0.65-0.71).


CONCLUSIONS
All models performed similarly. Because of greater ease of implementation, we recommend that existing algorithms be extended into older age groups.
Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia. Mark.Nelson@utas.edu.au
Mark R
MR
Nelson
Emmae
E
Ramsay
Philip
P
Ryan
Kristyn
K
Willson
Andrew M
AM
Tonkin
Lindon
L
Wing
Leon
L
Simons
Christopher M
CM
Reid
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008955:Models, Cardiovascular; D009043:Motor Activity; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011897:Random Allocation; D012306:Risk
D000925:Anticoagulants; D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents