Predicting hypotension, syncope, and fracture risk in patients indicated for antihypertensive treatment: the STRATIFY models.

IF 15.7 1区综合性期刊 Q1 MULTIDISCIPLINARY SCIENCES

Nature Communications Pub Date : 2025-10-23 DOI:10.1038/s41467-025-64408-9

Constantinos Koshiaris,Ariel Wang,Lucinda Archer,Richard D Riley,Kym Ie Snell,Richard J Stevens,Amitava Banerjee,Subhashisa Swain,Andrew Clegg,Christopher E Clark,Rupert A Payne,F D Richard Hobbs,Margaret Ogden,Richard J McManus,James P Sheppard,

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Abstract

Antihypertensives are associated with increased risk of syncope, hypotension, and fractures, but the highest-risk individuals are unclear. This study aimed to develop and validate three models to predict these outcomes in patients with an indication for antihypertensive treatment. A cohort study was conducted using data from Clinical Practice Research Datalink (CPRD). Patients aged 40+ with systolic blood pressure 130-179 mmHg were included. Outcomes were first hypotension, syncope, or fracture leading to hospitalization or death within 10 years. Models were derived from CPRD GOLD data (n = 1,773,224) and validated with CPRD Aurum data (n = 3,805,366). Each model had 31-37 predictors. Validation demonstrated strong discriminative ability (10-year C-statistic: hypotension 0.824; syncope 0.819; fracture 0.790), with close agreement between predicted and observed risks for the hypotension and syncope models. Some underprediction was observed for the fracture model. These models could be used to help reassure patients about the relatively low risk of harm from antihypertensive treatment, or identify the small number of individuals with a higher risk where additional monitoring may be indicated.

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预测降压治疗患者的低血压、晕厥和骨折风险：STRATIFY模型

降压药与晕厥、低血压和骨折的风险增加有关，但高危人群尚不清楚。本研究旨在建立和验证三个模型来预测降压治疗指征患者的这些结果。使用临床实践研究数据链（CPRD）的数据进行队列研究。患者年龄40岁以上，收缩压130-179 mmHg。结果为首次低血压、晕厥或骨折，导致10年内住院或死亡。模型来自CPRD GOLD数据（n = 1,773,224），并使用CPRD Aurum数据（n = 3,805,366）进行验证。每个模型有31-37个预测因子。验证显示了较强的判别能力（10年c统计值：低血压0.824；晕厥0.819；骨折0.790），低血压和晕厥模型的预测风险与观察风险非常吻合。断裂模型存在一定的低估。这些模型可以用来帮助患者确定抗高血压治疗的危害风险相对较低，或者确定少数风险较高的个体，可能需要进行额外的监测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Nature Communications Biological Science Disciplines-

CiteScore

24.90

自引率

2.40%

发文量

6928

审稿时长

3.7 months

期刊介绍： Nature Communications, an open-access journal, publishes high-quality research spanning all areas of the natural sciences. Papers featured in the journal showcase significant advances relevant to specialists in each respective field. With a 2-year impact factor of 16.6 (2022) and a median time of 8 days from submission to the first editorial decision, Nature Communications is committed to rapid dissemination of research findings. As a multidisciplinary journal, it welcomes contributions from biological, health, physical, chemical, Earth, social, mathematical, applied, and engineering sciences, aiming to highlight important breakthroughs within each domain.