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Posttreatment Blood Pressure as a Key Predictor in a 5-Year Stroke Prediction Model
Nan Zhang1, Jiarong Mei1, Fangfang Fan1
1Department of Cardiology, Peking University First Hospital, Beijing, China.
Insights
Hypertension significantly increases stroke risk. A new 5-year stroke prediction model for hypertensive individuals highlights long-term blood pressure control as the key factor for preventing strokes.
Area of Science:
- Cardiovascular Medicine
- Epidemiology
- Preventive Cardiology
Background:
- Hypertension is highly prevalent among stroke survivors, affecting 63.0%-84.2%.
- Existing stroke prediction tools do not specifically cater to individuals with hypertension.
- There is a critical need for a tailored stroke risk assessment for this population.
Purpose of the Study:
- To develop and validate a 5-year stroke risk prediction model for patients with hypertension.
- To identify key predictors of stroke in hypertensive individuals.
- To provide a tool for clinicians and patients to assess and manage stroke risk.
Main Methods:
- Utilized data from 20,702 hypertensive patients in the China Stroke Primary Prevention Trial (CSPPT).
- Collected treated blood pressure measurements every 3 months over the study period.
- Employed bootstrap resampling for internal validation and assessed predictive performance using C-index and calibration curves.
- Developed a random forest model to determine variable importance.
Main Results:
- The 5-year stroke risk prediction model includes 10 key risk factors.
- The most important predictors identified are average systolic blood pressure during treatment, age, and average diastolic blood pressure during treatment.
- Other significant factors include baseline blood pressure, diabetes history, cholesterol, folate levels, stress, smoking, and folic acid supplementation.
- The model achieved a C-statistic of 0.74 with good internal consistency.
Conclusions:
- Long-term posttreatment blood pressure is the primary predictor of stroke risk in hypertensive patients.
- The developed model and online calculator offer valuable tools for stroke risk assessment and prevention in this population.
- This research underscores the importance of continuous blood pressure management for stroke prevention in hypertensive individuals.
Abstract:
Evidence suggests that approximately 63.0%-84.2% of stroke survivors have hypertension, yet there is currently no stroke prediction tool specifically designed for individuals with hypertension. Using data from 20 702 hypertensive patients from the China Stroke Primary Prevention Trial (CSPPT), we developed a 5-year stroke risk prediction model. This prospective study collected treated blood pressure every 3 months, resulting in 22 measurements over the study period. The model was internally validated using bootstrap resampling, and its predictive performance was assessed with the C-index and calibration curves. We also developed a random forest model to rank the variable importance. The 5-year stroke risk prediction model for hypertensive individuals includes 10 risk factors, ranked by importance as follows: average systolic blood pressure during treatment, age, average diastolic blood pressure during treatment, baseline systolic blood pressure, history of diabetes, baseline total cholesterol level, baseline folate level, self-reported stress, smoking, and folic acid supplementation or not. The C statistic of the equation was 0.74 and there were no significant differences by gender or treatment group. Calibration plots indicate good internal consistency between observed and predicted 5-year stroke risk. We also developed an online calculator to assist clinicians and patients (https://zhouziyi.shinyapps.io/CSPPT/). Our study indicates that for patients with hypertension, long-term posttreatment blood pressure is the primary predictor of stroke risk. Trial Registration: The CSPPT (clinicaltrials.gov Identifier: NCT00794885).
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