Simple Integer Risk Score to Determine Prognosis of Patients With Hypertension and Chronic Stable Coronary Artery Disease

BACKGROUND: It is difficult to accurately determine prognosis of patients with hypertension and chronic stable coronary artery disease (CAD). Our aim was to construct a risk score for predicting important adverse events in this population. METHODS AND RESULTS: Patients with hypertension and chronic stable CAD enrolled in the INternational VErapamil-SR/Trandolapril STudy (INVEST) comprised the study cohort. Candidate predictor variables were obtained from patients with at least 1 postbaseline visit. Patients were divided into development (n=18 484) and validation cohorts (n=2054). Cox regression model identified predictors of the primary outcome: all-cause mortality, myocardial infarction, or stroke at a mean follow-up of 2.3 years. The hazard ratio of each variable was rounded to the nearest integer to construct score weights. A score 0 to 4 defined low-risk, 5 to 6 intermediate-risk and ≥7 high-risk. The following variables were retained in the final model: age, residence, body mass index, on-treatment heart rate and BP, prior myocardial infarction, heart failure, stroke/transient ischemic attack, smoking, diabetes, peripheral arterial disease, and chronic kidney disease. The primary outcome occurred in 2.9% of the low-risk group, 6.5% of the intermediate-risk group, and 18.0% of the high-risk group (P for trend <0.0001). The model was good at discriminating those who had an event versus those who did not (C-statistic=0.75). The model performed well in a validation cohort (C-statistic=0.77). CONCLUSION: Readily available clinical variables can rapidly stratify patients with hypertension and chronic stable CAD into useful risk categories.