Validation of the Framingham hypertension risk score in a middle eastern population: Tehran lipid and glucose study (TLGS)

• Main Authors: Fatemeh Koohi, Ewout W. Steyerberg, Leila Cheraghi, Alireza Abdshah, Fereidoun Azizi, Davood Khalili
• Format: Article
• Language: English
• Published: BMC 2021-04-01
• Series: BMC Public Health
• Subjects: Hypertension; Blood pressure; Risk prediction; Risk score; Primary prevention
• Online Access: https://doi.org/10.1186/s12889-021-10760-6

Abstract Background The Framingham hypertension risk score is a well-known and simple model for predicting hypertension in adults. In the current study, we aimed to assess the predictive ability of this model in a Middle Eastern population. Methods We studied 5423 participants, aged 20–69 years, without hypertension, who participated in two consecutive examination cycles of the Tehran Lipid and Glucose Study (TLGS). We assessed discrimination based on Harrell’s concordance statistic (c-index) and calibration (graphical comparison of predicted vs. observed). We evaluated the original, recalibrated (for intercept and slope), and revised (for beta coefficients) models. Results Over the 3-year follow-up period, 319 participants developed hypertension. The Framingham hypertension risk score performed well in discriminating between individuals who developed hypertension and those who did not (c-index = 0.81, 95% CI: 0.79–0.83). Initially, there was a systematic underestimation of the original risk score (events predicted), which was readily corrected by a simple model revision. Conclusions The revised Framingham hypertension risk score can be used as a screening tool in public health and clinical practice to facilitate the targeting of preventive interventions in high-risk Middle Eastern people.