Fig. 4: Associations between HTN-AI and incident cardiovascular outcomes compared to baseline blood pressure.

To compare the associations of blood pressure measurements and the HTN-AI score with incidence cardiovascular outcomes, we performed cause-specific hazard regression of five cardiovascular outcomes (mortality, heart failure, myocardial infarction, ischemic stroke, and aortic dissection or rupture) against each of HTN-AI, baseline systolic blood pressure, and baseline pulse pressure, with adjustment for age, sex, baseline hypertension status, baseline hypertension medication use, diabetes, hyperlipidemia, body mass index, and current smoking status. Pulse pressure was included in place of diastolic blood pressure due to the non-linear relationship between diastolic blood pressure and age. The figure depicts a forest plot of the results, with each hazard ratio representing the adjusted subdistribution hazard ratio per standard deviation of the covariate. Error bars represent 95% confidence intervals. Across all outcomes, the effect size per standard deviation of the HTN-AI score is greater than the corresponding effect size per standard deviation of each blood pressure metric. Our results suggest that the HTN-AI score captures more information about risk of hypertension-associated cardiovascular disease than does office blood pressure measurement. BP: blood pressure. HR: hazard ratio. SD: standard deviation.