Gender-specific clinical risk scores incorporating blood pressure variability for predicting incident dementia

Journal article


Zhou, Jiandong, Lee, Sharen, Wong, Wing Tak, Waleed, Khalid Bin, Leung, K., Lee, Teddy Tai Loy, Wai, Abraham Ka Chung, Liu, Tong, Chang, Carlin, Cheung, Bernard Man Yung, Zhang, Q. and Tse, G. 2021. Gender-specific clinical risk scores incorporating blood pressure variability for predicting incident dementia. Journal of the American Medical Informatics Association : JAMIA. 29 (2), pp. 335-347. https://doi.org/10.1093/jamia/ocab173
AuthorsZhou, Jiandong, Lee, Sharen, Wong, Wing Tak, Waleed, Khalid Bin, Leung, K., Lee, Teddy Tai Loy, Wai, Abraham Ka Chung, Liu, Tong, Chang, Carlin, Cheung, Bernard Man Yung, Zhang, Q. and Tse, G.
AbstractIntroduction: The present study examined the gender-specific prognostic value of blood pressure (BP) and its variability in the prediction of dementia risk and developed a score system for risk stratification. Materials and Methods This was a retrospective, observational population-based cohort study of patients admitted to government-funded family medicine clinics in Hong Kong between January 1, 2000 and March 31, 2002 with at least 3 blood pressure measurements. Gender-specific risk scores for dementia were developed and tested. Results The study consisted of 74 855 patients, of whom 3550 patients (incidence rate: 4.74%) developed dementia over a median follow-up of 112 months (IQR= [59.8–168]). Nonlinear associations between diastolic/systolic BP measurements and the time to dementia presentation were identified. Gender-specific dichotomized clinical scores were developed for males (age, hypertension, diastolic and systolic BP and their measures of variability) and females (age, prior cardiovascular, respiratory, gastrointestinal diseases, diabetes mellitus, hypertension, stroke, mean corpuscular volume, monocyte, neutrophil, urea, creatinine, diastolic and systolic BP and their measures of variability). They showed high predictive strengths for both male (hazard ratio [HR]: 12.83, 95% confidence interval [CI]: 11.15–14.33, P value < .0001) and female patients (HR: 26.56, 95% CI: 14.44–32.86, P value < .0001). The constructed gender-specific scores outperformed the simplified systems without considering BP variability (C-statistic: 0.91 vs 0.82), demonstrating the importance of BP variability in dementia development. Conclusion Gender-specific clinical risk scores incorporating BP variability can accurately predict incident dementia and can be applied clinically for early disease detection and optimized patient management.
KeywordsHealth informatics; blood pressure variability ; Risk score; Risk stratification; Predictive model; Dementia
Year2021
JournalJournal of the American Medical Informatics Association : JAMIA
Journal citation29 (2), pp. 335-347
PublisherOxford University Press
ISSN1527-974X
Digital Object Identifier (DOI)https://doi.org/10.1093/jamia/ocab173
Official URLhttps://academic.oup.com/jamia/article-abstract/29/2/335/6395277
FunderNational Natural Science Foundation of China
Health and Medical Research Fund of the Food and Health Bureau of Hong Kong
Innovation and Technology Fund of Innovation and Technology Commission of Hong Kong
National Key Research and Development Program of China
Ministry of Science and Technology of China
Publication dates
Online13 Oct 2021
Print12 Jan 2022
Publication process dates
Accepted10 Aug 2021
Deposited16 Jun 2022
Accepted author manuscript
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Output statusPublished
Licensehttps://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model
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