Validating the Framingham Hypertension Risk Score. Results From the Whitehall II Study.
Hypertension. 2009 Jul 13. Kivimäki M, Batty GD, Singh-Manoux A, Ferrie JE, Tabak AG, Jokela M, Marmot MG, Davey Smith G, Shipley MJ. Department of Epidemiology and Public Health, University College London, London, United Kingdom; Institut National de la Sante' et de la Recherche Me'dicale, Paris, France; Medical Research Council Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom; Semmelweis University Faculty of Medicine, 1st Department of Medicine, Budapest, Hungary; Finnish Institute of Occupational Health and Department of Psychology, University of Helsinki, Helsinki, Finland; Medical Research Council Centre for Causal Analyses in Translational Epidemiology, Department of Social Medicine, University of Bristol, Bristol, United Kingdom.
A promising hypertension risk prediction score using data from the US Framingham Offspring Study has been developed, but this score has not been tested in other cohorts. We examined the predictive performance of the Framingham hypertension risk score in a European population, the Whitehall II Study. Participants were 6704 London-based civil servants aged 35 to 68 years, 31% women, free from prevalent hypertension, diabetes mellitus, and coronary heart disease. Standard clinical examinations of blood pressure, weight and height, current cigarette smoking, and parental history of hypertension were undertaken every 5 years for a total of 4 times. We recorded a total of 2043 incident (new-onset) cases of hypertension in three 5-year baseline follow-up data cycles. Both discrimination (C statistic: 0.80) and calibration (Hosmer-Lemeshow chi(2): 11.5) of the Framingham hypertension risk score were good. Agreement between the predicted and observed hypertension incidences was excellent across the risk score distribution. The overall predicted:observed ratio was 1.08, slightly better among individuals >50 years of age (0.99 in men and 1.02 in women) than in younger participants (1.16 in men and 1.18 in women). Reclassification with a modified score on the basis of our study population did not improve the prediction (net reclassification improvement: -0.5%; 95% CI: -2.5% to 1.5%).
These data suggest that the Framingham hypertension risk score provides a valid tool with which to estimate near-term risk of developing hypertension.