Key result
Adding diastolic blood pressure fails to improve machine learning prediction of cardiovascular outcomes.
Why the study?
Randomized trials have focused on systolic blood pressure lowering, leaving the safety of diastolic blood pressure reduction unresolved with conflicting results across registries and trial analyses.
Does including diastolic blood pressure in machine learning models improve the prediction of cardiovascular outcomes in high-risk hypertensive patients?
Does including diastolic blood pressure in machine learning models improve the prediction of cardiovascular outcomes in high-risk hypertensive patients?
Machine learning analysis of SPRINT trial data demonstrates that diastolic blood pressure does not independently improve cardiovascular risk prediction, supporting intensive systolic blood pressure lowering regardless of low DBP.
Answers are grounded in this paper and cite their sources.
DBP may not independently enhance ML-based CV risk prediction; hypothesis-generating and should not yet change practice.
Background: The guidelines recommend intensive blood pressure control. Randomized trials have focused on the relevance of the systolic blood pressure (SBP) lowering, leaving the safety of the diastolic blood pressure (DBP) reduction unresolved. There are data available which show that low DBP should not stop clinicians from achieving SBP targets; however, registries and analyses of randomized trials present conflicting results. The purpose of the study was to apply machine learning (ML) algorithms to determine, whether DBP is an important risk factor to predict stroke, heart failure (HF), myocardial infarction (MI), and primary outcome in the SPRINT trial database. Methods: ML experiments were performed using decision tree, random forest, k-nearest neighbor, naive Bayesian, multi-layer perceptron, and logistic regression algorithms, including and excluding DBP as the risk factor in an unselected and selected (DBP < 70 mmHg) study population. Results: Including DBP as the risk factor did not change the performance of the machine learning models evaluated using accuracy, AUC, mean, and weighted F-measure, and was not required to make proper predictions of stroke, MI, HF, and primary outcome. Conclusions: Analyses of the SPRINT trial data using ML algorithms imply that DBP should not be treated as an independent risk factor when intensifying blood pressure control.
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Siński et al. (2022) studied Hypertension with increased cardiovascular risk (n=9,361). Diastolic blood pressure (DBP) inclusion in predictive models vs. Exclusion of DBP from predictive models was evaluated on Prediction performance (accuracy, AUC, mean F-measure, weighted F-measure) for cardiovascular outcomes. Adding diastolic blood pressure to machine learning models did not change their performance in predicting cardiovascular outcomes, suggesting it is not an independent risk factor.
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