[Predictive validity of the risk SCORE model in a Mediterranean population with arterial hypertension]

Area of Science:

• Cardiology
• Preventive Medicine
• Public Health

Background:

• Hypertension is a leading global risk factor for cardiovascular disease.
• Accurate cardiovascular risk assessment is crucial for guiding treatment in hypertensive patients.
• The SCORE scale is a tool used to estimate cardiovascular risk.

Purpose of the Study:

• To evaluate the predictive accuracy and clinical usefulness of the SCORE scale.
• To assess the SCORE scale's ability to predict cardiovascular events and all-cause mortality in hypertensive individuals.
• To identify factors influencing the diagnostic performance of the SCORE scale.

Main Methods:

• Utilized data from the ESCARVAL-RISK cohort of hypertensive patients.
• Calculated cardiovascular risk using the SCORE scale.
• Monitored cardiovascular events and mortality over a 5-year follow-up period.
• Determined sensitivity, specificity, and predictive values for various SCORE cut-off points.

Main Results:

• In 9834 patients, the 5% risk threshold for treatment initiation showed high specificity (91-92%) but low sensitivity (20-22%) for events and death.
• The SCORE scale incorrectly classified a high percentage (78-80%) of patients who experienced events or died as low risk.
• Factors like age, BMI, retinopathy, and anticoagulant use diminished the scale's accuracy, while being female improved it.

Conclusions:

• The SCORE scale demonstrates limited predictive power for cardiovascular disease and overall mortality in hypertensive populations.
• Current risk stratification using the SCORE scale may not be sufficient for optimal management of hypertension.
• Further research into more accurate risk prediction models for hypertension is warranted.