JMIR Medical Informatics (Oct 2024)

Predictive Models for Sustained, Uncontrolled Hypertension and Hypertensive Crisis Based on Electronic Health Record Data: Algorithm Development and Validation

  • Hieu Minh Nguyen,
  • William Anderson,
  • Shih-Hsiung Chou,
  • Andrew McWilliams,
  • Jing Zhao,
  • Nicholas Pajewski,
  • Yhenneko Taylor

DOI
https://doi.org/10.2196/58732
Journal volume & issue
Vol. 12
pp. e58732 – e58732

Abstract

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Abstract BackgroundAssessing disease progression among patients with uncontrolled hypertension is important for identifying opportunities for intervention. ObjectiveWe aim to develop and validate 2 models, one to predict sustained, uncontrolled hypertension (≥2 blood pressure [BP] readings ≥140/90 mm Hg or ≥1 BP reading ≥180/120 mm Hg) and one to predict hypertensive crisis (≥1 BP reading ≥180/120 mm Hg) within 1 year of an index visit (outpatient or ambulatory encounter in which an uncontrolled BP reading was recorded). MethodsData from 142,897 patients with uncontrolled hypertension within Atrium Health Greater Charlotte in 2018 were used. Electronic health record–based predictors were based on the 1-year period before a patient’s index visit. The dataset was randomly split (80:20) into a training set and a validation set. In total, 4 machine learning frameworks were considered: L2-regularized logistic regression, multilayer perceptron, gradient boosting machines, and random forest. Model selection was performed with 10-fold cross-validation. The final models were assessed on discrimination (C-statistic), calibration (eg, integrated calibration index), and net benefit (with decision curve analysis). Additionally, internal-external cross-validation was performed at the county level to assess performance with new populations and summarized using random-effect meta-analyses. ResultsIn internal validation, the C-statistic and integrated calibration index were 0.72 (95% CI 0.71‐0.72) and 0.015 (95% CI 0.012‐0.020) for the sustained, uncontrolled hypertension model, and 0.81 (95% CI 0.79‐0.82) and 0.009 (95% CI 0.007‐0.011) for the hypertensive crisis model. The models had higher net benefit than the default policies (ie, treat-all and treat-none) across different decision thresholds. In internal-external cross-validation, the pooled performance was consistent with internal validation results; in particular, the pooled C-statistics were 0.70 (95% CI 0.69‐0.71) and 0.79 (95% CI 0.78‐0.81) for the sustained, uncontrolled hypertension model and hypertensive crisis model, respectively. ConclusionsAn electronic health record–based model predicted hypertensive crisis reasonably well in internal and internal-external validations. The model can potentially be used to support population health surveillance and hypertension management. Further studies are needed to improve the ability to predict sustained, uncontrolled hypertension.