High performance of a risk calculator that includes renal function in predicting mortality of hypertensive patients in clinical application

J Hypertens. 2014 Jun;32(6):1245-54. doi: 10.1097/HJH.0000000000000177.


Objective: The aim of this study was to assess the accuracy of a risk calculator that includes renal function as compared with that of the traditional Framingham Risk Score (FRS) in predicting the risk of mortality of hypertensive individuals managed in primary care.

Methods: From the databases of British and Italian General Practitioners, we retrieved demographic and clinical data for 35 101 UK and 27 818 Italian individuals aged 35-74 years with a diagnosis of hypertension. Then, the 5-year incidence of cardiovascular events as well as all-cause and cardiovascular mortality were recorded for both samples. A comparison analysis of the performance of the Individual Data Analysis of Antihypertensive Intervention Trials (INDANA) calculator with that of FRS in predicting 5-year all-cause and cardiovascular mortality risk was made.

Results: The INDANA calculator was more accurate than the FRS in predicting all-cause [Δc 0.038, 95% confidence interval (CI) 0.026-0.051 for United Kingdom, and 0.018, 95% CI 0.010-0.027 for Italy, both P < 0.0001] and cardiovascular mortality (Δc 0.050, 95% CI 0.027-0.074 for United Kingdom, and 0.080, 95% CI 0.059-0.101 for Italy, both P < 0.0001). By using the INDANA calculator, 20% of the UK and 10% of the Italian patients were reclassified to higher risk classes for all-cause mortality, and 25 and 28%, respectively were reclassified when cardiovascular mortality was assessed (P < 0.0001 for all).

Conclusion: The INDANA calculator proved to be more accurate than the FRS in predicting the risk of mortality in hypertensive patients and should be considered for systematic adoption for risk stratification of hypertensive individuals managed in primary care.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Algorithms
  • Antihypertensive Agents / therapeutic use*
  • Clinical Trials as Topic
  • Databases, Factual
  • Electrocardiography
  • Female
  • Humans
  • Hypertension / mortality
  • Hypertension / physiopathology*
  • Italy
  • Kidney / physiopathology*
  • Male
  • Middle Aged
  • Primary Health Care / organization & administration
  • Probability
  • ROC Curve
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Treatment Outcome
  • United Kingdom


  • Antihypertensive Agents