SCORE has been built from different population-based cohorts established in the seventies and in the eighties including only few hypertensive patients. Current European guidelines recommend estimating 10-year cardiovascular mortality using SCORE for patients in primary prevention; yet, the significance of SCORE in hypertensives has not been tested in dedicated cohorts.

The objective of the present study was to compare the cardiovascular mortality predicted by SCORE with the observed mortality in a cohort of hypertensive patients addressed in a tertiary centre with a long follow-up.

We used the OLD-HTA Lyon cohort including all patients referred for a work-up of hypertension from 1970 to 1975, i.e. at the same period of time than the cohorts used for constructing SCORE. Patients with previous myocardial infarction were excluded from the present analysis. Patients were classified according to four subgroups: low risk (SCORE<1%), moderate risk (1%≤SCORE<5%), high risk (5%≤SCORE<10%) and very high risk (SCORE≥10%). All-cause and cardiovascular mortality were censored in year.

In total, 1907 patients were included in the present study with the following baseline characteristics: 45.0±13.4 years, 60.6% men, blood pressure 182±32/104±20mmHg, eGFR 89±34mL/min, total cholesterol 5.8±1.1mmol/L, 13.0% of diabetes and SCORE 2.9±4.1. Patients were classified in the 4 subgroups as follows: low-risk (n=550), moderate risk (n=934), high risk (n=287) and very high risk (n=136). Fig. 1 indicates the survival analysis using Kaplan–Meier curves. The 10-years cardiovascular mortality rate was 2 to 3-fold higher than that predicted by SCORE.

SCORE has a strong value to stratify cardiovascular mortality at 10 years but also for longer periods of time. However it is not well calibrated to severe hypertensive patients, since, in this population, it underestimated markedly cardiovascular mortality.