Predicting the Risk of Incident Hypertension in a Korean Middle‐Aged Population: Korean Genome and Epidemiology Study

Abstract

The objectives of this study were to construct a risk score for predicting incident hypertension by using the Korean Genome and Epidemiology Study (KoGES) data and to compare the performance between KoGES and the Framingham model. A total of 4747 participants were analyzed. The entire cohort was randomly assigned to derivation and validation sets at a ratio of 6:4. A hypertension risk score was developed based on the derivation cohort, using the same risk factors that were used for developing the Framingham hypertension risk score. The accuracy of KoGES and Framingham models was evaluated in terms of calibration and discrimination. The area under receiver operating characteristic (AROC) curves were 0.789 for the Framingham model and 0.791 for the KoGES model. The AROC calculated for the point-based risk score was 0.790, which is almost identical to that for the KoGES model. The Framingham model showed poor agreement (v 2 =29.73, P=.0002) and underestimated the risk of hypertension in most deciles of predicted risk. The model based on KoGES yielded results similar to the observed risk of hypertension (v 2 =4.17, P=.8415). This study demonstrates that the Framingham risk score based on data from a non-Korean population can lead to the underestimation of the prediction risk of hypertension. J Clin Hypertens (Greenwich).

Validation of the Korean Genome Epidemiology Study Risk Score to Predict Incident Hypertension in a Large Nationwide Korean Cohort

“…22 Similarly, our previous study in a Korean population demonstrated that the Framingham risk score underestimated risk for HT even though the individuals in both studies had similar risk factors at baseline. 13 Although the discrimination was similar to that in the Framingham Offspring Study, concordance between observed and predicted risk was poor even after recalibration of the Framingham model, suggesting that risk models may not be accurate in different ethnic populations even after adjusting the model. Another study in a Chinese cohort showed that the Framingham model had good calibration but lower discrimination than risk models developed from the original cohort.…”

“…13 Most risk scores used to predict HT have not been validated externally in a different data source. According to a recent review article, only the Framingham and Hopkins scores have been evaluated in populations or ethnic groups that are different from those used for initial development of the model.…”

“…To directly apply the regression coefficients of both models to the NSC data, we calculated weighted averages of the distribution of the parental history of HT in the Framingham and KoGES studies. 10,11, 13 The BP-only model, which used systolic and diastolic BPs, was constructed using multiple logistic regression analysis. We compared discrimination using area under the receiver-operating characteristic curves (AROCs) according to the method of DeLong et al and calibration using the goodness-of-fit test procedure based on Hosmer and Lameshow's treatment, health examination, and medical care institution databases, and has been described in detail previously.…”

Development of a risk prediction model for incident hypertension in a working-age Japanese male population

“…Several risk prediction models for incident hypertension have been recently developed in Western, [13][14][15][16][17] Middle Eastern 18 and Asian 19,20 countries. Most of these models 13,14,[16][17][18][19][20] consist of simple clinical parameters and self-reported data, including information regarding lifestyle factors.…”

“…Most of these models 13,14,[16][17][18][19][20] consist of simple clinical parameters and self-reported data, including information regarding lifestyle factors. The simplicity and user-friendliness of these models allow for their easy application in daily clinical practice as tools designed to prevent hypertension.…”