Predicting hypotension, syncope, and fracture risk in patients indicated for antihypertensive treatment: the STRATIFY models
Antihypertensives are associated with increased risk of syncope, hypotension, and fractures, but the highest-risk individuals are unclear. This study aimed to develop and validate three models to predict these outcomes in patients with an indication for antihypertensive treatment. A cohort study was conducted using data from Clinical Practice Research Datalink (CPRD). Patients aged 40+ with systolic blood pressure 130-179 mmHg were included. Outcomes were first hypotension, syncope, or fracture leading to hospitalization or death within 10 years. Models were derived from CPRD GOLD data (n = 1,773,224) and validated with CPRD Aurum data (n = 3,805,366). Each model had 31-37 predictors. Validation demonstrated strong discriminative ability (10-year C-statistic: hypotension 0.824; syncope 0.819; fracture 0.790), with close agreement between predicted and observed risks for the hypotension and syncope models. Some underprediction was observed for the fracture model. These models could be used to help reassure patients about the relatively low risk of harm from antihypertensive treatment, or identify the small number of individuals with a higher risk where additional monitoring may be indicated.
Authors
- Richard Stevens (ORCID: https://orcid.org/0000-0002-9258-4060)
- Andrew Clegg (ORCID: https://orcid.org/0000-0001-5972-1097)
- Richard Hobbs (ORCID: https://orcid.org/0000-0001-7976-7172)
- Simon J. Griffin (ORCID: https://orcid.org/0000-0002-2157-4797)
- Rupert Payne (ORCID: https://orcid.org/0000-0002-5842-4645)
- Ariel Wang (ORCID: https://orcid.org/0000-0001-5360-9993)
- James P Sheppard (ORCID: https://orcid.org/0000-0002-4461-8756)
- Richard D Riley (ORCID: https://orcid.org/0000-0001-8699-0735)
- Juliet A. Usher‐Smith (ORCID: https://orcid.org/0000-0002-8501-2531)
- Kym I E Snell (ORCID: https://orcid.org/0000-0001-9373-6591)
- Amitava Banerjee (ORCID: https://orcid.org/0000-0001-8741-3411)
- Christopher Elles Clark (ORCID: https://orcid.org/0000-0002-7526-3038)
- Margaret Ogden (ORCID: https://orcid.org/0000-0002-4611-5095)
- Lucinda Archer (ORCID: https://orcid.org/0000-0003-2504-2613)
- Richard J. McManus (ORCID: https://orcid.org/0000-0003-3638-028X)
- Constantinos Koshiaris (ORCID: https://orcid.org/0000-0002-9821-7608)
- Subhashisa Swain (ORCID: https://orcid.org/0000-0001-9207-1065)
Institutions
- Brighton and Sussex Medical School (GB)
- Birmingham City University (GB)
- University of Leeds (GB)
- University of Nicosia (CY)
- University of Exeter (GB)
- University of Cambridge (GB)
- University of Oxford (GB)
- NIHR Birmingham Biomedical Research Centre (GB)
- The Patients Association (GB)
- University College London (GB)
- University of Birmingham (GB)
Publication Details
- Journal
- Nature Communications
- Published
- 2025-10-23
- DOI
- https://doi.org/10.1038/s41467-025-64408-9
- Citations
- 1
- Primary Topic
- Cardiovascular Syncope and Autonomic Disorders
- Type
- article
- Field-Weighted Citation Impact
- 2.01
Funders
- Wellcome Trust
- University Hospitals Birmingham NHS Foundation Trust
- UK Research and Innovation
- National Institute for Health and Care Research
- Department of Health and Social Care
- Curtin University of Technology
- Birmingham Biomedical Research Centre