Prediction of transfer among multiple states of blood pressure based on Markov model: an 18-year cohort study

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This study aimed to identify the rules of transition between normotension, prehypertension and hypertension states and to establish a prediction model for the incidence of prehypertension and hypertension.


Data from the China Health and Nutrition Survey from 1991 to 2009 were used as training data to develop the model. Data of the year 2011 were used for model validation. The multistate Markov model was developed using the msm package in R software.


A total of 5265 participants were included at baseline, with an average follow-up of 8.05 ± 5.27 years and 17 640 observations. The ratio of men to women was 1 : 1.17, and the mean age was 37.54 ± 13.80 years. Within 10 years, in men, from normotension, the average probability to prehypertension and hypertension are 34.5 and 35.25%, respectively; from prehypertension, the average probability of recovering to normotension and developing to hypertension are 17.78 and 43.85%, respectively. In women, the average probabilities are 27.49, 28.09, 29.11 and 39.05%. Fat consumption increasing was found to be a protective factor, with 4.5% lower rate of transferring from normotension to prehypertension for a quarter percentage increasing. The model showed a very good prediction ability within 10 years and provided good prediction of blood pressure in the 2011 cohort (χ2 = 0.781, P = 0.676).


The multistate Markov model can be a useful tool to identify the rules of transition among multiple states of blood pressure and predict well prevalence of the normotension, prehypertension and hypertension in cohort populations.

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