CALIBER Hypertension phenotype

person Phenotype Hypertension
person Type Disease or syndrome
person Data sources Primary care (CPRD), hospital admission data (HES)
person Clinical Terminologies Read, ICD-10, ICD-9, OPCS-4
person Valid event date range 01/01/1999 - 01/07/2016
person Sex Female/Male
person Agreed 23.11.2012 (Revision 2)
person Authors Julie George, Emily Herrett, Liam Smeeth, Harry Hemingway, Anoop Shah, Spiros Denaxas

Primary Care (incident)

In the Clinical Practice Research Datalink (CPRD, primary care data) we ascertained hypertension (HT) cases by searching for Read terms related to HT diagnosis OR inference from blood pressure reading OR prescriptions of blood pressure lowering medications.

The thresholds are based on the NICE treatment targets: 150/90 for people aged over 80 and 140/90 otherwise.

Medication: at least two prescriptions of blood pressure lowering medication within 6 months from British National Formulary chapters 2.2.1 (Thiazides), 2.2.3 (loop diuretics), 2.2.4 (Potassium-sparing diuretics with other diuretics), 2.4 (beta blockers), 2.5 (hypertension and heart failure related medication) and 2.6.2 (calcium-channel blockers).

Read codeRead termCALIBER category
6624.00 Borderline hyperten:yearly obs Hypertension
6627.00 Good hypertension control Hypertension
6628.00 Poor hypertension control Hypertension
662F.00 Hypertension treatm. started Hypertension
662G.00 Hypertensive treatm.changed Hypertension
662O.00 On treatment for hypertension Hypertension
662b.00 Moderate hypertension control Hypertension
662c.00 Hypertension six month review Hypertension
662d.00 Hypertension annual review Hypertension
662r.00 Trial withdrawal of antihypertensive therapy Hypertension
7Q01.00 High cost hypertension drugs Hypertension
8B26.00 Antihypertensive therapy Hypertension
8BL0.00 Patient on maximal tolerated antihypertensive therapy Hypertension
8I3N.00 Hypertension treatment refused Hypertension
F404200 Blind hypertensive eye Hypertension
F421300 Hypertensive retinopathy Hypertension
G2...00 Hypertensive disease Hypertension
G2...11 BP - hypertensive disease Hypertension
G20..00 Essential hypertension Hypertension
G200.00 Malignant essential hypertension Hypertension
G201.00 Benign essential hypertension Hypertension
G202.00 Systolic hypertension Hypertension
G203.00 Diastolic hypertension Hypertension
G20z.00 Essential hypertension NOS Hypertension
G20z.11 Hypertension NOS Hypertension
G21..00 Hypertensive heart disease Hypertension
G210.00 Malignant hypertensive heart disease Hypertension
G210000 Malignant hypertensive heart disease without CCF Hypertension
G210100 Malignant hypertensive heart disease with CCF Hypertension
G211.00 Benign hypertensive heart disease Hypertension
G211000 Benign hypertensive heart disease without CCF Hypertension
G211100 Benign hypertensive heart disease with CCF Hypertension
G21z.00 Hypertensive heart disease NOS Hypertension
G21z000 Hypertensive heart disease NOS without CCF Hypertension
G21z011 Cardiomegaly - hypertensive Hypertension
G21z100 Hypertensive heart disease NOS with CCF Hypertension
G21zz00 Hypertensive heart disease NOS Hypertension
G22..00 Hypertensive renal disease Hypertension
G220.00 Malignant hypertensive renal disease Hypertension
G221.00 Benign hypertensive renal disease Hypertension
G222.00 Hypertensive renal disease with renal failure Hypertension
G22z.00 Hypertensive renal disease NOS Hypertension
G22z.11 Renal hypertension Hypertension
G23..00 Hypertensive heart and renal disease Hypertension
G230.00 Malignant hypertensive heart and renal disease Hypertension
G231.00 Benign hypertensive heart and renal disease Hypertension
G232.00 Hypertensive heart&renal dis wth (congestive) heart failure Hypertension
G233.00 Hypertensive heart and renal disease with renal failure Hypertension
G234.00 Hyperten heart&renal dis+both(congestv)heart and renal fail Hypertension
G23z.00 Hypertensive heart and renal disease NOS Hypertension
G2y..00 Other specified hypertensive disease Hypertension
G2z..00 Hypertensive disease NOS Hypertension
G672.00 Hypertensive encephalopathy Hypertension
G672.11 Hypertensive crisis Hypertension
Gyu2.00 [X]Hypertensive diseases Hypertension
L122.00 Other pre-existing hypertension in preg/childbirth/puerp Hypertension
L122000 Other pre-existing hypertension in preg/childb/puerp unspec Hypertension
L122100 Other pre-existing hypertension in preg/childb/puerp - deliv Hypertension
L122300 Other pre-exist hypertension in preg/childb/puerp-not deliv Hypertension
L122z00 Other pre-existing hypertension in preg/childb/puerp NOS Hypertension
L127.00 Pre-eclampsia or eclampsia with pre-existing hypertension Hypertension
L127z00 Pre-eclampsia or eclampsia + pre-existing hypertension NOS Hypertension
L128.00 Pre-exist hypertension compl preg childbirth and puerperium Hypertension
L128000 Pre-exist hyperten heart dis compl preg childbth+puerperium Hypertension
L128200 Pre-exist 2ndry hypertens comp preg childbth and puerperium Hypertension
TJC7.00 Adverse reaction to other antihypertensives Hypertension
TJC7z00 Adverse reaction to antihypertensives NOS Hypertension
U60C500 [X]Oth antihyperten drug caus advers eff in therap use, NEC Hypertension
U60C511 [X] Adverse reaction to other antihypertensives Hypertension
U60C51A [X] Adverse reaction to antihypertensives NOS Hypertension
6146200 Hypertension induced by oral contraceptive pill Secondary hypertension
G24..00 Secondary hypertension Secondary hypertension
G240.00 Secondary malignant hypertension Secondary hypertension
G240000 Secondary malignant renovascular hypertension Secondary hypertension
G240z00 Secondary malignant hypertension NOS Secondary hypertension
G241.00 Secondary benign hypertension Secondary hypertension
G241000 Secondary benign renovascular hypertension Secondary hypertension
G241z00 Secondary benign hypertension NOS Secondary hypertension
G244.00 Hypertension secondary to endocrine disorders Secondary hypertension
G24z.00 Secondary hypertension NOS Secondary hypertension
G24z000 Secondary renovascular hypertension NOS Secondary hypertension
G24z100 Hypertension secondary to drug Secondary hypertension
G24zz00 Secondary hypertension NOS Secondary hypertension
Gyu2100 [X]Hypertension secondary to other renal disorders Secondary hypertension
Read terms are hierarhically organized in top-level chapters i.e. chapter G....00 is related to Circulatory System Diseases and sub-headings i.e. heading G2...00 is related to Hypertensive Heart Disease while G3...00 is related to Ischaemic Heart Disease.

Secondary Care (incident and prevalent)

In Hospital Episode Statistics (HES, secondary care data) we used ICD-10 codes (see below) for HT diagnosis when marked as the primary diagnosis i.e. the main condition treated or investigated during the relevant episode of healthcare OR OPCS codes for use of hyptertension drugs during hospital procedures. We used the date of admission to hospital as the date of the event.

ICD-10 codeICD-10 termCALIBER category
I10 Essential (primary) hypertension Hypertension
I11 Hypertensive heart disease Hypertension
I12 Hypertensive renal disease Hypertension
I13 Hypertensive heart and renal disease Hypertension
I15 Secondary hypertension Secondary hypertension

OPCS-4 codeOPCS-4 termCALIBER category
X82.8 Other specified high cost hypertension drugs Hypertension
X82.9 Unspecified high cost hypertension drugs Hypertension
Not applicable.

Combining evidence across sources to define and date phenotypes

HT is defined as either a explicit diagnosis in primary or secondary care, or implicity based on blood pressure readings or prescription of blood pressure controll medications in primary care.
Chung, Sheng-Chia, Mar Pujades-Rodriguez, Bram Duyx, Spiros C. Denaxas, Laura Pasea, Aroon Hingorani, Adam Timmis, Bryan Williams, and Harry Hemingway. "Time spent at blood pressure target and the risk of death and cardiovascular diseases." PloS one 13, no. 9 (2018): e0202359.
Chung, Sheng-Chia, Mar Pujades-Rodriguez, Bram Duyx, Spiros C. Denaxas, Laura Pasea, Aroon Hingorani, Adam Timmis, Bryan Williams, and Harry Hemingway. "Time spent at blood pressure target and the risk of death and cardiovascular diseases." PloS one 13, no. 9 (2018): e0202359.
Gho JMIH et al. An electronic health records cohort study on heart failure following myocardial infarction in England: incidence and predictors. BMJ Open. 2018 Mar 3;8(3):e018331. doi: 10.1136/bmjopen-2017-018331. PMID: 29502083

Steele AJ et al. Machine learning models in electronic health records can outperform conventional survival models for predicting patient mortality in coronary artery disease. PLoS One. 2018 Aug 31;13(8):e0202344. doi: 10.1371/journal.pone.0202344. eCollection 2018. PMID: 30169498

Archangelidi O et al. Clinically recorded heart rate and incidence of 12 coronary, cardiac, cerebrovascular and peripheral arterial diseases in 233,970 men and women: A linked electronic health record study. Eur J Prev Cardiol. 2018 Sep;25(14):1485-1495. doi: 10.1177/2047487318785228. Epub 2018 Jul 2. PMID: 29966429

Koudstaal S et al. Prognostic burden of heart failure recorded in primary care, acute hospital admissions, or both: a population-based linked electronic health record cohort study in 2.1 million people. Eur J Heart Fail. 2017 Sep;19(9):1119-1127. doi: 10.1002/ejhf.709. Epub 2016 Dec 23. PMID: 28008698

Chung SC et al. Time spent at blood pressure target and the risk of death and cardiovascular diseases. PLoS One. 2018 Sep 5;13(9):e0202359. doi: 10.1371/journal.pone.0202359. eCollection 2018. PMID: 30183734

Bell S et al. Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records. BMJ. 2017 Mar 22;356:j909. PMID: 28331015

Pasea L et al. Personalising the decision for prolonged dual antiplatelet therapy: development, validation and potential impact of prognostic models for cardiovascular events and bleeding in myocardial infarction survivors. Eur Heart J. 2017 Apr 7;38(14):1048-1055. doi: 10.1093/eurheartj/ehw683. PMID: 28329300

Shah AD et al. Neutrophil Counts and Initial Presentation of 12 Cardiovascular Diseases: A CALIBER Cohort Study. J Am Coll Cardiol. 2017 Mar 7;69(9):1160-1169. doi: 10.1016/j.jacc.2016.12.022. PMID: 28254179

Asaria M et al. Using electronic health records to predict costs and outcomes in stable coronary artery disease. Heart. 2016 May 15;102(10):755-62. doi: 10.1136/heartjnl-2015-308850. Epub 2016 Feb 10. PMID: 26864674

Daskalopoulou M et al. Depression as a Risk Factor for the Initial Presentation of Twelve Cardiac, Cerebrovascular, and Peripheral Arterial Diseases: Data Linkage Study of 1.9 Million Women and Men. PLoS One. 2016 Apr 22;11(4):e0153838. doi: 10.1371/journal.pone.0153838. eCollection 2016. PMID: 27105076

Pujades-Rodriguez M et al. Associations between polymyalgia rheumatica and giant cell arteritis and 12 cardiovascular diseases. Heart. 2016 Mar;102(5):383-9. doi: 10.1136/heartjnl-2015-308514. Epub 2016 Jan 19. PMID: 26786818

Pujades-Rodriguez M et al. Rheumatoid Arthritis and Incidence of Twelve Initial Presentations of Cardiovascular Disease: A Population Record-Linkage Cohort Study in England. PLoS One. 2016 Mar 15;11(3):e0151245. doi: 10.1371/journal.pone.0151245. eCollection 2016. PMID: 26978266

Shah AD et al. Low eosinophil and low lymphocyte counts and the incidence of 12 cardiovascular diseases: a CALIBER cohort study. Open Heart. 2016 Sep 5;3(2):e000477. doi: 10.1136/openhrt-2016-000477. eCollection 2016. PMID: 27621833

Timmis A et al. Prolonged dual antiplatelet therapy in stable coronary disease: comparative observational study of benefits and harms in unselected versus trial populations. BMJ. 2016 Jun 22;353:i3163. PMID: 27334486

Walker S et al. Long-term healthcare use and costs in patients with stable coronary artery disease: a population-based cohort using linked health records (CALIBER). Eur Heart J Qual Care Clin Outcomes. 2016 Jan 20;2(2):125-140. doi: 10.1093/ehjqcco/qcw003. PMID: 27042338

George J et al. How Does Cardiovascular Disease First Present in Women and Men? Incidence of 12 Cardiovascular Diseases in a Contemporary Cohort of 1,937,360 People. Circulation. 2015 Oct 6;132(14):1320-8. doi: 10.1161/CIRCULATIONAHA.114.013797. Epub 2015 Sep 1. PMID: 26330414

Morley KI et al. Defining disease phenotypes using national linked electronic health records: a case study of atrial fibrillation. PLoS One. 2014 Nov 4;9(11):e110900. doi: 10.1371/journal.pone.0110900. eCollection 2014. PMID: 25369203

Pujades-Rodriguez M et al. Heterogeneous associations between smoking and a wide range of initial presentations of cardiovascular disease in 1937360 people in England: lifetime risks and implications for risk prediction. Int J Epidemiol. 2015 Feb;44(1):129-41. doi: 10.1093/ije/dyu218. Epub 2014 Nov 20. PMID: 25416721

Pujades-Rodriguez M et al. Socioeconomic deprivation and the incidence of 12 cardiovascular diseases in 1.9 million women and men: implications for risk prediction and prevention. PLoS One. 2014 Aug 21;9(8):e104671. doi: 10.1371/journal.pone.0104671. eCollection 2014. PMID: 25144739

Rapsomaniki E et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet. 2014 May 31;383(9932):1899-911. doi: 10.1016/S0140-6736(14)60685-1. PMID: 24881994

Shah AD et al. Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1.9 million people. Lancet Diabetes Endocrinol. 2015 Feb;3(2):105-13. doi: 10.1016/S2213-8587(14)70219-0. Epub 2014 Nov 11. PMID: 25466521

Rapsomaniki E et al. Prognostic models for stable coronary artery disease based on electronic health record cohort of 102 023 patients. Eur Heart J. 2014 Apr;35(13):844-52. doi: 10.1093/eurheartj/eht533. Epub 2013 Dec 17. PMID: 24353280