Related Experiment Video
Updated: Dec 8, 2025
Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis
Published on: September 26, 2018
Cardiovascular disease risk stratification by the Framigham score is markedly improved by ambulatory compared with
Ramón C Hermida1, Diana E Ayala2, Artemio Mojón2
1Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidad de Vigo, Campus Universitario, Vigo, Pontevedra, Spain; Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, United States.
Insights
Ambulatory blood pressure monitoring (ABPM) offers superior cardiovascular disease (CVD) risk prediction compared to office BP measurements. A new model using ABPM data significantly improves CVD risk stratification accuracy over traditional methods.
Area of Science:
- Cardiology and Cardiovascular Research
- Hypertension and Blood Pressure Monitoring
- Preventive Medicine and Public Health
Background:
- Office blood pressure measurements (OBPM) are traditionally used for cardiovascular disease (CVD) risk stratification.
- Current CVD risk models rely on OBPM and traditional risk factors, despite evidence that ambulatory blood pressure monitoring (ABPM) better predicts outcomes.
- There is a need for improved CVD risk stratification models that incorporate more accurate BP measurements.
Purpose of the Study:
- To compare the diagnostic accuracy, discrimination, and performance of traditional CVD risk scores with a novel model using ABPM-derived parameters.
- To evaluate the clinical utility of ABPM in refining CVD risk stratification beyond OBPM.
- To develop and validate a new CVD risk stratification model (RS_ABPM) incorporating sleep-time BP data.
Main Methods:
- Utilized data from 19,949 participants in the Hygia Project, employing 48-hour ABPM.
- Compared the original Framingham risk score (RS_OFG) and its adjusted version (RS_AFG) against a novel RS_ABPM model.
- RS_ABPM replaced OBPM with sleep-time systolic BP (SBP) mean and sleep-time relative SBP decline as predictive factors.
Main Results:
- During up to 12.7 years of follow-up, 1854 participants experienced a primary CVD outcome.
- Sleep-time SBP and relative SBP decline were significant ABPM-derived predictors of CVD risk.
- The RS_ABPM model demonstrated significantly improved calibration, accuracy, discrimination, and performance compared to RS_OFG and RS_AFG (P<.001).
Conclusions:
- CVD risk stratification based solely on OBPM, as in the Framingham score, has significant limitations.
- Around-the-clock ABPM is clinically valuable for accurately diagnosing hypertension and reliably assessing CVD risk.
- The novel RS_ABPM model offers superior CVD risk prediction, highlighting the importance of incorporating ABPM data.
Introduction And Objectives:
Ambulatory blood pressure (BP) better predicts cardiovascular disease (CVD) outcomes than office BP measurements (OBPM). Nonetheless, current CVD risk stratification models continue to rely on exclusively daytime OBPM along with traditional factors, eg, age, sex, smoking, dyslipidemia, and/or diabetes.
Methods:
Data from 19 949 participants of the primary care-based Hygia Project assessed by 48-hour ambulatory BP monitoring (ABPM) and without prior CVD events were used to compare the diagnostic accuracy, discrimination, and performance of the original Framingham risk score (RSOFG) and its adjusted version to the Hygia Project study population (RSAFG) with that of a novel CVD risk stratification model constructed by replacing OBPM with ABPM-derived prognostic parameters (RSABPM).
Results:
During the follow-up, lasting up to 12.7 years, 1854 participants experienced a primary CVD outcome of CVD death, myocardial infarction, coronary revascularization, heart failure, stroke, transient ischemic attack, angina pectoris, or peripheral artery disease. Asleep systolic BP (SBP) mean and sleep-time relative SBP decline were the only joint significant ABPM-derived predictive factors of CVD risk and were therefore used to substitute for in-clinic SBP in the RSABPM model. The RSABPM model, in comparison with the RSOFG and RSAFG models, showed significantly improved calibration, diagnostic accuracy, discrimination, and performance (always P<.001). The RSAFG-derived event-probabilities of 57.3% of the participants were outside the 95% confidence limits of the event probability determined by the RSABPM model.
Conclusions:
These collective findings reveal important limitations of CVD risk stratification when based upon OBPM, as in the Framingham score, and corroborate the clinical value of around-the-clock ABPM to properly diagnose true hypertension and reliably stratify CVD vulnerability.
Related Concept Videos
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:25Errors occurring during blood pressure monitoring
Several factors...
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:23Assessment of blood pressure in brachial artery(two-step method)
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies
01:11Assessing Blood pressure in the Leg
Preparation: