Related Experiment Videos
Coronary and cardiovascular risk estimation in uncomplicated mild hypertension. A comparison of risk assessment
Joseph I N M Yikona1, Erica J Wallis, Lawrence E Ramsay
1Clinical Pharmacology and Therapeutics, Royal Hallamshire Hospital, Gossop Road, Sheffield S10 2JF, UK.
Insights
The Sheffield table and Joint British Societies (JBS) Chart accurately identify coronary heart disease (CHD) risk in mild hypertension patients. Other methods showed lower accuracy for cardiovascular disease (CVD) risk assessment.
Area of Science:
- Cardiology
- Public Health
- Risk Assessment
Background:
- Mild hypertension is common, and accurate risk stratification for cardiovascular events is crucial.
- Existing risk assessment tools vary in their effectiveness for identifying high-risk individuals.
- The Framingham risk functions are a standard for calculating coronary heart disease (CHD) and cardiovascular disease (CVD) risk.
Purpose of the Study:
- To compare the accuracy of five risk assessment methods for identifying patients with uncomplicated mild hypertension at high CHD and CVD risk.
- To evaluate the performance of the Sheffield table, Joint British Societies (JBS) Chart, New Zealand (NZ) Chart, World Health Organization/International Society of Hypertension (WHO-ISH), and United States Joint National Committee VI (JNC-VI) methods.
- To determine which risk assessment tools are most reliable for this patient population.
Main Methods:
- A comparison of risk estimates from five distinct risk assessment methods.
- Utilized data from the 1995 Scottish Health Survey, focusing on individuals aged 35-64 with mild systolic hypertension (SBP 140-159 mmHg).
- Assessed accuracy using sensitivity, specificity, and predictive values against CHD risk of 15% and CVD risk of 20% over 10 years.
Main Results:
- The Sheffield table and JBS Chart demonstrated good sensitivity and specificity (over 90%) for identifying 10-year CHD risk.
- The New Zealand (NZ) Chart showed acceptable sensitivity (83%) and specificity (89%) for CHD risk.
- For 10-year CVD risk, all three charts (Sheffield, JBS, NZ) were less accurate, though the Sheffield table maintained the highest sensitivity (81%).
- WHO-ISH and JNC-VI methods exhibited high sensitivity but very poor specificity (under 50%) for both CHD and CVD risk.
Conclusions:
- The Sheffield table and JBS Chart are effective tools for identifying 10-year CHD risk in patients with uncomplicated mild hypertension.
- The NZ Chart is less accurate for CHD risk assessment compared to Sheffield and JBS methods.
- For CVD risk assessment, all evaluated methods showed reduced accuracy, with the Sheffield table performing best.
- WHO-ISH and JNC-VI methods are unsuitable for this population due to their inability to reliably differentiate high-risk individuals.
Objective:
To compare the accuracy of five risk assessment methods in identifying patients with uncomplicated mild hypertension at high coronary heart disease (CHD) and cardiovascular disease (CVD) risk.DESIGN Comparison of risk estimates using each risk assessment method with CHD risk 15% and CVD risk 20% over 10 years calculated using the Framingham risk functions.
Setting:
British population.
Subjects:
People aged 35-64 years with uncomplicated mild systolic hypertension (systolic blood pressure (SBP) 140-159 mmHg, = 202) from the 1995 Scottish Health Survey.
Main Outcome Measures:
Sensitivity, specificity, positive and negative predictive values.
Results:
Compared with CHD risk 15% over 10 years, the Sheffield table and Joint British Societies (JBS) Chart had good sensitivity and specificity ( 90%). The New Zealand (NZ) Chart had sensitivity 83% and specificity 89%. Compared with CVD risk 20% over 10 years the Sheffield table had sensitivity 81%, the JBS Chart had sensitivity 63%, and the NZ Chart had sensitivity 75%. All had good specificity ( 90%). For CHD risk and CVD risk the World Health Organization/International Society of Hypertension (WHO-ISH) and United States Joint National Committee VI (JNC-VI) methods had high sensitivity at the cost of very poor specificity ( 50%).
Conclusion:
In patients with uncomplicated mild hypertension, the Sheffield table and JBS Chart both identified CHD risk 15% over 10 years with acceptable accuracy, while the NZ Chart was less accurate. Compared with CVD risk 20% over 10 years, these three risk assessment methods were all less accurate, but the Sheffield table retained the highest sensitivity ( 0.05 versus JBS Chart, = NS versus NZ Chart). The WHO-ISH and JNC-VI methods had unacceptably low specificities compared with both measures of risk and failed to differentiate between those at high and low risk.