# Hypertension Risk Prediction Calculator
## Detailed User Manual

### Version Information
- **Version**: 1.0
- **Date**: October 22, 2025
- **Developer**: Research Team from Suzhou Ninth People's Hospital
- **Based on**: Data from 10,639 community-dwelling seniors in Jiangling Sub-district, Suzhou, China

---

## 1. Introduction

### 1.1 Background
Hypertension is a major public health problem among older adults, affecting 50-60% of individuals aged ≥60 years globally. This calculator was developed to provide a simple, cost-effective tool for predicting hypertension risk in community-dwelling seniors using routine health examination data.

### 1.2 Purpose
The primary purpose of this calculator is to:
- Predict the probability of hypertension in community-dwelling seniors
- Classify individuals into risk categories (Low/Moderate/High)
- Provide evidence-based recommendations for clinical management
- Support decision-making in primary care and community health settings

### 1.3 Target Population
This calculator is specifically designed for:
- Community-dwelling adults aged ≥60 years
- Individuals undergoing routine health examinations
- Primary care and community health service providers

It is **not suitable** for:
- Hospitalized patients
- Individuals with secondary hypertension
- Adults under 60 years of age
- Patients with acute illnesses affecting blood pressure

---

## 2. Technical Specifications

### 2.1 Model Development
- **Model Type**: Logistic Regression
- **Sample Size**: 10,639 community-dwelling seniors
- **Age Range**: 60-98 years (mean: 68.2 ± 6.1 years)
- **Hypertension Prevalence**: 57.38%
- **Development Software**: Python 3.12 with scikit-learn library

### 2.2 Predictor Variables
The calculator uses three key predictors:

| Variable | Description | Units | Range |
|----------|-------------|-------|-------|
| Age | Chronological age | Years | 60-98 |
| HDL-C | High-density lipoprotein cholesterol | mmol/L | 0.5-2.5 |
| LDL-C | Low-density lipoprotein cholesterol | mmol/L | 1.0-5.0 |

### 2.3 Model Performance

| Metric | Value | 95% CI | Interpretation |
|--------|-------|--------|----------------|
| AUC | 0.6382 | 0.6214-0.6550 | Moderate discriminative ability |
| Sensitivity | 68.2% | - | Correctly identifies 68.2% of hypertensive individuals |
| Specificity | 56.4% | - | Correctly identifies 56.4% of non-hypertensive individuals |
| Positive Predictive Value | 66.3% | - | 66.3% of positive predictions are actual cases |
| Negative Predictive Value | 58.5% | - | 58.5% of negative predictions are actual non-cases |

---

## 3. Installation and Setup

### 3.1 System Requirements
- **Software**: Microsoft Excel 2016 or later, or compatible spreadsheet software
- **Operating System**: Windows 10/11, macOS 10.14 or later
- **File Size**: Approximately 85 KB
- **Memory**: Minimal requirements (runs on standard office computers)

### 3.2 Installation Steps
1. Download the Excel file: "Hypertension_Risk_Prediction_Calculator_English.xlsx"
2. Save it to a convenient location on your computer
3. Double-click the file to open it in Excel
4. Enable macros if prompted (required for full functionality)

### 3.3 Security Considerations
- The calculator does not collect or store any personal health information
- All calculations are performed locally on your computer
- No internet connection is required for operation
- The file is digitally signed for security verification

---

## 4. User Interface Guide

### 4.1 Main Calculator Interface
The main interface is located in the "Hypertension Risk Calculator" worksheet and consists of five main sections:

#### 4.1.1 Title Section
- Displays the calculator name and development information
- Provides context about the study population

#### 4.1.2 Input Parameters Section
- **Age Field**: Enter age in years (60-98)
- **HDL-C Field**: Enter high-density lipoprotein cholesterol in mmol/L
- **LDL-C Field**: Enter low-density lipoprotein cholesterol in mmol/L

#### 4.1.3 Calculation Button
- Click to initiate risk calculation
- Results update automatically in most Excel versions

#### 4.1.4 Prediction Results Section
- **Risk Probability**: Displays the calculated hypertension risk (0.000-1.000)
- **Risk Category**: Shows Low/Moderate/High Risk classification
- **Performance Metrics**: Displays sensitivity, specificity, and PPV

#### 4.1.5 Risk Interpretation Section
- Provides detailed explanations of each risk category
- Includes recommended clinical actions for each category

### 4.2 Instructions Worksheet
The "User Instructions" worksheet provides:
- Step-by-step usage guide
- Troubleshooting tips
- Technical support information

---

## 5. Step-by-Step Usage Instructions

### 5.1 Basic Operation
1. **Open the Calculator**
   - Launch Microsoft Excel
   - Open the file: "Hypertension_Risk_Prediction_Calculator_English.xlsx"
   - Select the "Hypertension Risk Calculator" worksheet

2. **Enter Patient Data**
   - In cell B6 (Age), enter the patient's age in years (e.g., 68)
   - In cell B7 (HDL-C), enter the HDL-C value in mmol/L (e.g., 1.3)
   - In cell B8 (LDL-C), enter the LDL-C value in mmol/L (e.g., 3.2)

3. **View Results**
   - The risk probability will appear in cell B12
   - The risk category will appear in cell D12
   - Results update automatically in real-time

### 5.2 Example Calculation
**Example**: 68-year-old male with HDL-C = 1.3 mmol/L and LDL-C = 3.2 mmol/L

1. Enter "68" in the Age field
2. Enter "1.3" in the HDL-C field
3. Enter "3.2" in the LDL-C field
4. **Expected Result**: Risk probability ≈ 0.62, Risk category = High Risk

### 5.3 Batch Processing
For multiple patients:
1. Create a copy of the calculator worksheet for each patient
2. Enter data in each copy
3. Compile results in a separate summary worksheet
4. Use Excel's data analysis tools for statistical summaries

---

## 6. Risk Classification and Clinical Recommendations

### 6.1 Risk Categories

#### 6.1.1 Low Risk (< 20%)
- **Definition**: Probability of hypertension is less than 20%
- **Clinical Significance**: Low probability of having hypertension
- **Recommended Actions**:
  - Annual routine health examination
  - Routine blood pressure monitoring during checkups
  - Lifestyle counseling for hypertension prevention
  - No additional testing required

#### 6.1.2 Moderate Risk (20% - 50%)
- **Definition**: Probability of hypertension is between 20% and 50%
- **Clinical Significance**: Moderate probability of having hypertension
- **Recommended Actions**:
  - Blood pressure monitoring every 6 months
  - Comprehensive lifestyle intervention:
    - Sodium restriction (< 5 g/day)
    - Regular aerobic exercise (30 minutes, 5 days/week)
    - Weight management (BMI < 28 kg/m²)
    - Smoking cessation counseling
  - Annual lipid profile assessment

#### 6.1.3 High Risk (> 50%)
- **Definition**: Probability of hypertension exceeds 50%
- **Clinical Significance**: High probability of having hypertension
- **Recommended Actions**:
  - Monthly blood pressure monitoring (home and office)
  - Immediate medical evaluation by a physician
  - Consideration of preventive medication:
    - Low-dose thiazide diuretics
    - Calcium channel blockers
    - Angiotensin-converting enzyme inhibitors
  - Comprehensive cardiovascular risk assessment
  - Dietary consultation with a registered dietitian

### 6.2 Special Populations

#### 6.2.1 Frail Elderly (> 80 years)
- Use lower threshold (15% instead of 20%) for high-risk classification
- Consider polypharmacy risks when recommending medications
- Focus on non-pharmacological interventions

#### 6.2.2 Diabetic Patients
- Lower threshold for intervention (10% risk)
- More frequent monitoring (monthly)
- Aggressive lifestyle management

#### 6.2.3 Patients with Cardiovascular Disease
- All patients with known CVD should be classified as high risk
- Regardless of calculated probability
- Refer to cardiologist for specialized care

---

## 7. Quality Control and Validation

### 7.1 Internal Validation
The model was validated using:
- 70% training set / 30% test set split
- 10-fold cross-validation
- Bootstrapping (1000 iterations)
- Multiple imputation for missing data

### 7.2 External Validation
Recommended validation steps for new populations:
1. Collect data from 200-500 individuals
2. Apply the calculator to the new dataset
3. Compare predicted vs. observed hypertension status
4. Calculate calibration and discrimination metrics
5. Adjust model if necessary for local population

### 7.3 Quality Assurance
To ensure accurate results:
- Verify input values against laboratory reports
- Check for outliers in input parameters
- Confirm risk category assignments
- Document all calculations in patient records

---

## 8. Troubleshooting and Technical Support

### 8.1 Common Issues

#### 8.1.1 Calculation Errors
- **Issue**: "Please enter valid parameters" message
- **Causes**:
  - Age outside 60-98 range
  - HDL-C outside 0.5-2.5 mmol/L range
  - LDL-C outside 1.0-5.0 mmol/L range
- **Solutions**:
  - Verify input values
  - Check unit conversions (ensure mmol/L not mg/dL)
  - Contact laboratory for confirmation

#### 8.1.2 Formula Not Calculating
- **Issue**: Results not updating automatically
- **Solutions**:
  - Press F9 to force recalculation
  - Check Excel calculation settings (should be "Automatic")
  - Verify formula integrity in cell B12

#### 8.1.3 Compatibility Issues
- **Issue**: Worksheet appears distorted
- **Solutions**:
  - Update Excel to latest version
  - Use compatibility mode for older versions
  - Adjust column widths manually

### 8.2 Technical Support
For technical issues or questions:

**Email Support**: xykk@qq.com
**Phone Support**: +86-13063866027
**Response Time**: 24-48 hours
**Support Hours**: Monday-Friday, 8:00 AM-5:00 PM CST

### 8.3 Software Updates
- Check for updates quarterly
- Subscribe to email notifications for new versions
- Backup custom templates before updating

---

## 9. Integration with Clinical Workflows

### 9.1 Primary Care Settings
**Integration Points**:
- Annual wellness visits
- Chronic disease management appointments
- Preoperative evaluations
- Geriatric assessments

**Documentation Requirements**:
- Date of risk assessment
- Input parameters used
- Calculated risk probability
- Risk category
- Recommended interventions
- Patient education provided

### 9.2 Community Health Services
**Implementation Strategies**:
- Train community health workers in calculator use
- Integrate with mobile health screening programs
- Use in health education workshops
- Incorporate into senior center wellness programs

### 9.3 Electronic Health Record Integration
**Data Import/Export**:
- Export results to EHR systems
- Import laboratory data automatically
- Generate standardized progress notes
- Create population health reports

---

## 10. Research Applications

### 10.1 Study Design
The calculator can be used in:
- Cross-sectional prevalence studies
- Prospective cohort studies
- Intervention effectiveness trials
- Health services research

### 10.2 Outcome Measures
**Primary Outcomes**:
- Hypertension prevalence
- Risk category distribution
- Prediction accuracy
- Clinical decision impact

**Secondary Outcomes**:
- Healthcare utilization
- Cost-effectiveness
- Patient satisfaction
- Provider adherence

### 10.3 Statistical Analysis
**Recommended Analyses**:
- Receiver operating characteristic (ROC) curves
- Calibration plots
- Decision curve analysis
- Net reclassification improvement
- Integrated discrimination improvement

---

## 11. Training and Education

### 11.1 Provider Training
**Training Components**:
- Model development and validation
- Clinical interpretation of results
- Communication with patients
- Documentation requirements
- Quality assurance

**Training Methods**:
- Online modules (1-2 hours)
- Hands-on workshops (3-4 hours)
- Case-based learning
- Continuing education credits

### 11.2 Patient Education
**Key Messages**:
- Risk prediction vs. diagnosis
- Importance of regular monitoring
- Lifestyle modification strategies
- Medication adherence
- Follow-up recommendations

**Educational Materials**:
- Patient-friendly risk charts
- Lifestyle modification guides
- Medication information sheets
- Appointment reminder cards

---

## 12. Ethical Considerations

### 12.1 Informed Consent
- Patients should understand:
  - The calculator provides risk prediction, not diagnosis
  - Results are based on population data
  - Individual results may vary
  - Additional testing may be needed

### 12.2 Privacy and Confidentiality
- All patient data must be protected
- Use secure storage for calculator files
- De-identify data for research purposes
- Comply with local privacy regulations

### 12.3 Equity and Access
- Ensure calculator is accessible to all seniors
- Consider language and literacy barriers
- Provide assistance to those with limited computer skills
- Validate in diverse populations

---

## 13. Future Developments

### 13.1 Planned Improvements
- Incorporation of additional predictors:
  - Lifestyle factors
  - Family history
  - Biomarkers
  - Imaging data
- Mobile application version
- Integration with wearable devices
- Artificial intelligence enhancements

### 13.2 Research Directions
- External validation in diverse populations
- Longitudinal assessment of predictive value
- Cost-effectiveness analysis
- Comparative effectiveness research

---

## 14. References and Citations

### 14.1 Primary Reference
Du H, Fei X, Liu Q, et al. Development and Validation of a Hypertension Prediction Model for Community-Dwelling Older Adults Using Routine Health Examination Data. [Submitted to BMC Geriatrics, 2024]

### 14.2 Methodological References
1. Sterne JAC, White IR, Carlin JB, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ. 2009;338:b2393.
2. Vickers AJ, Elkin EB. Decision curve analysis: a novel method for evaluating prediction models. Med Decis Making. 2006;26(6):565-574.
3. Steyerberg EW, Vickers AJ, Cook NR, et al. Assessing the performance of prediction models: a framework for some traditional and novel measures. Epidemiology. 2010;21(1):128-138.

### 14.3 Clinical Guidelines
1. Chinese Geriatrics Society, Chinese Society of Cardiology. 2023 Chinese guidelines for geriatric hypertension management. Chin J Geriatr Heart Brain Vessel Dis. 2023;22(10):1001-1026.
2. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520.
3. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-3104.

---

## 15. Appendices

### 15.1 Formula Reference
The risk calculation formula is:

```
logit(p) = -5.238 + 0.041 × Age - 0.345 × HDL-C + 0.156 × LDL-C
p = 1 / (1 + e^(-logit(p)))
```

Where:
- p = Probability of hypertension
- Age = Patient age in years
- HDL-C = High-density lipoprotein cholesterol in mmol/L
- LDL-C = Low-density lipoprotein cholesterol in mmol/L

### 15.2 Conversion Factors
For converting between units:
- **HDL-C**: mg/dL × 0.0259 = mmol/L
- **LDL-C**: mg/dL × 0.0259 = mmol/L
- **Total Cholesterol**: mg/dL × 0.0259 = mmol/L

### 15.3 Sample Data
Example patient data for testing:

| Patient ID | Age | HDL-C (mmol/L) | LDL-C (mmol/L) | Expected Risk | Risk Category |
|------------|-----|----------------|----------------|---------------|---------------|
| 001 | 65 | 1.2 | 3.5 | 0.65 | High Risk |
| 002 | 72 | 1.5 | 2.8 | 0.48 | Moderate Risk |
| 003 | 68 | 1.8 | 2.2 | 0.18 | Low Risk |
| 004 | 80 | 1.1 | 4.1 | 0.78 | High Risk |
| 005 | 62 | 1.4 | 3.0 | 0.32 | Moderate Risk |

### 15.4 Frequently Asked Questions (FAQs)

**Q: Can this calculator be used for patients under 60 years old?**
A: No, the calculator was specifically developed for adults aged 60 years and older.

**Q: How often should the risk assessment be repeated?**
A: Annual reassessment is recommended for most patients. High-risk patients may need more frequent assessments.

**Q: Does the calculator account for medication use?**
A: The current version does not explicitly account for medication use. Patients on antihypertensive medications should be considered high risk regardless of calculated probability.

**Q: Can the calculator be used for hypertensive patients to assess control?**
A: No, this calculator predicts the probability of having hypertension, not the quality of control in known hypertensive patients.

**Q: Is the calculator validated in other populations?**
A: The calculator was developed and validated in Chinese community-dwelling seniors. External validation in other populations is ongoing.

---

## 16. Contact Information

### 16.1 Primary Investigator
**Huan Du, Chief Physician**
- Department of Rehabilitation Medicine
- Suzhou Ninth People's Hospital
- No. 2666 Ludang Road, Songling Street
- Wujiang District, 215200 Suzhou, Jiangsu Province, China
- Email: xykk@qq.com
- Phone: +86-13063866027
- ORCID: 0009-0009-0130-6240

### 16.2 Research Team
**Xiaojun Fei, Co-first Author**
- Department of Rehabilitation Medicine
- Suzhou Ninth People's Hospital
- Email: [Contact information available upon request]

**Airong Wang, Co-corresponding Author**
- Community Health Service Center of Jiangling Sub-district
- Wujiang District, Suzhou, Jiangsu Province, China
- Email: genew@126.com
- Phone: +86-13706257456

### 16.3 Technical Support
For technical issues with the calculator:
- Email: xykk@qq.com
- Subject Line: "Hypertension Calculator Support"
- Include: Detailed description of the issue, Excel version, operating system

### 16.4 Feedback and Suggestions
We welcome feedback to improve the calculator:
- Feature requests
- Bug reports
- Clinical implementation experiences
- Research collaboration opportunities

---

*Last Updated: October 22, 2025*
*Version: 1.0*
