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High performance of a risk calculator that includes renal function in predicting mortality of hypertensive patients in clinical application

Ravera, Mauraa; Cannavò, Rossellaa; Noberasco, Giuseppeb; Guasconi, Alessandroc; Cabib, Ursulaa; Pieracci, Lauraa; Pegoraro, Valeriac; Brignoli, Ovidiob; Cricelli, Claudiob; Deferrari, Giacomoa; Paoletti, Ernestoa

doi: 10.1097/HJH.0000000000000177
ORIGINAL PAPERS: Cardiovascular risk

Objective: The aim of this study was to assess the accuracy of a risk calculator that includes renal function as compared with that of the traditional Framingham Risk Score (FRS) in predicting the risk of mortality of hypertensive individuals managed in primary care.

Methods: From the databases of British and Italian General Practitioners, we retrieved demographic and clinical data for 35 101 UK and 27 818 Italian individuals aged 35–74 years with a diagnosis of hypertension. Then, the 5-year incidence of cardiovascular events as well as all-cause and cardiovascular mortality were recorded for both samples. A comparison analysis of the performance of the Individual Data Analysis of Antihypertensive Intervention Trials (INDANA) calculator with that of FRS in predicting 5-year all-cause and cardiovascular mortality risk was made.

Results: The INDANA calculator was more accurate than the FRS in predicting all-cause [Δc 0.038, 95% confidence interval (CI) 0.026–0.051 for United Kingdom, and 0.018, 95% CI 0.010–0.027 for Italy, both P < 0.0001] and cardiovascular mortality (Δc 0.050, 95% CI 0.027–0.074 for United Kingdom, and 0.080, 95% CI 0.059–0.101 for Italy, both P < 0.0001). By using the INDANA calculator, 20% of the UK and 10% of the Italian patients were reclassified to higher risk classes for all-cause mortality, and 25 and 28%, respectively were reclassified when cardiovascular mortality was assessed (P < 0.0001 for all).

Conclusion: The INDANA calculator proved to be more accurate than the FRS in predicting the risk of mortality in hypertensive patients and should be considered for systematic adoption for risk stratification of hypertensive individuals managed in primary care.

aDivision of Nephrology, Dialysis and Transplantation, University of Genoa IRCCS – Azienda Ospedaliera Universitaria San Martino – IST – Genoa

bItalian College of General Practitioners (SIMG), Florence

cCegedim Strategic Data Medical Research, Milan, Italy

Correspondence to Dr Ernesto Paoletti, MD, Nephrology, Dialysis and Transplantation, University of Genoa; IRCCS – Azienda Ospedaliera Universitaria San Martino – IST, 16132 Genova, Italy. Tel: +39 010 5553878; fax: +39 010 5556652; e-mail: ernesto.paoletti@hsanmartino.it

Abbreviations: ACE-I, angiotensin-converting enzyme inhibitors; ARB, angiotensin II receptor blockers; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; FRS, Framingham Risk Score; HDL, high-density lipoprotein; LDL, low-density lipoprotein; LVH, left ventricular hypertrophy; NRI, Net Reclassification Index; ROC, area under the receiver operating characteristic

Received 17 July, 2013

Revised 16 December, 2013

Accepted 14 February, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins