Hypertensive Heart Disease (PAF of 1 with hypertension)

Abbreviations
Abbreviation	Definition	Note
HHD	Hypertensive heart disease
HF	Heart failure

Disease Overview 

Hypertensive heart disease refers to a constellation of changes in the left ventricle, left atrium and coronary arteries as a result of chronic blood pressure elevation, which increases the workload on the heart inducing structural and functional changes. These changes include hypertrophy of the left ventricle, which can progress to heart failure; patients with left ventricular hypertrophy have significantly increased morbidity and mortality. Hypertensive heart disease ultimately encompasses all of the direct and indirect sequelae of chronic high blood pressure which include systolic or diastolic heart failure, conduction arrhythmias, especially atrial fibrillation, and increased risk of coronary artery disease. [NCBI]

GBD 2019 Modeling Strategy 

GBD 2019 Non-Fatal Modeling Strategy

In GBD, hypertensive heart disease is modeled as an outcome of the heart failure impairment envelope. The case definition for heart failure is a clinical diagnosis using structured criteria such as the Framingham or European Society of Cardiology criteria. Beginning in GBD 2016, we used ACC/AHA Stage C and above to capture both persons who are currently symptomatic and those who have been diagnosed with heart failure but are currently asymptomatic. [McKee] [European-society-cardiology]

GBD 2019 Fatal Modeling Strategy

We included vital registration data in a standard CODEm approach to model hypertensive heart disease.

[GBD-2019-Capstone-Appendix-HHD]

Cause Hierarchy

Restrictions

The following table describes any restrictions in GBD 2019 on the effects of this cause (such as being only fatal or only nonfatal), as well as restrictions on the ages and sexes to which the cause applies.

GBD 2019 Cause Restrictions
Restriction Type	Value	Notes
Male only	False
Female only	False
YLL only	False
YLD only	False
YLL age group start	15	[15, 19 years), age_group_id=8
YLL age group end	125	[95, 125 years), age_group_id=235
YLD age group start	15	[15, 19 years), age_group_id=8
YLD age group end	125	[95, 125 years), age_group_id=235

Vivarium Modeling Strategy 

Scope

Hypertensive heart disease should occur at the incidence of HF in the DisMod model multiplied by the proportion of heart failure that is due to HHD. Heart failure due to HHD is then a chronic state without remission. Transition from prevalent HF due to hypertensive heart disease to death should occur at the GBD EMR rate from the HF DisMod model. The transition rate from the susceptible state to the prevalent state should be modified by systolic blood pressure and high body mass index.

Assumptions and Limitations

The proportion splits for HHD are the same for incidence and prevalence

Cause Model Diagram

State and Transition Data Tables

Definitions

State Definitions
State	State Name	Definition
S	Susceptible to HHD	Simulant that has not been diagnosed with HF due to HHD
P	Prevalent HF due to HHD	Simulant with prevalent HF due to HHD

States Data

States Data
State	Measure	Value	Notes
All	cause-specific mortality (CSMR)	\(\frac{\text{deaths\_c498}}{\text{population}}\)	Post CoDCorrect cause-level CSMR
S	prevalence	1-prevalence_c498
P	prevalence	\(\sum\limits_{s\in sequelae} \text{prevalence}_s\)	There are 4 sequelae
P	excess mortality	emr_m2412	EMR from the HF envelope model
P	disability weight	\(\frac{1}{\text{prevalence\_c498}} \times \sum\limits_{s\in sequelae} \text{disability\_weight}_s \cdot \text{prevalence}_s\)

Transition Data

Transition Data
Transition	Source	Sink	Value	Notes
1	S	P	\({\text{incidence\_m2412}} \times \text{propHF\_HHD}\)	This is the incidence of HF due to HHD, assuming that the split for incidence is the same as prevalence

Data Sources

Data Sources
Value	Sources	Description	Notes
prevalence_c498	como	Prevalence of HHD	All HF-related sequelae
deaths_c498	codcorrect	Deaths from HHD
incidence_m2412	dismod	Incidence of overall HF
propHF_HHD	CVD Team	Proportion of HF that is due to HHD	Proportion file in /share/scratch
population	demography	Mid-year population for given age/sex/year/location
sequelae_c498	gbd mapping	List of 4 sequelae for HHD
prevalence_s{sid}	como	Prevalence of sequela with id sid
disability_weight_s{sid}	YLD appendix	Disability weight of sequela with id sid
emr_m2412	dismod-mr 2.1	excess mortality rate of heart failure	This is the EMR value for the overall HF envelope; not HHD-specific
sequelae	sequelae definition	{s5750, s406, s407, s408}

Validation Criteria

Compare CSMR experienced by simulants to CSMR from CoDCorrect in GBD
Compare prevalence experienced by simulants to post-COMO prevalence in GBD

References 

[NCBI]

Tackling G, Borhade MB. Hypertensive Heart Disease. [Updated 2021 Feb 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539800/

[McKee]

McKee, P. A., Castelli, W. P., McNamara, P. M., & Kannel, W. B. (1971). The natural history of congestive heart failure: the Framingham study. New England Journal of Medicine, 285(26), 1441-1446.

[European-society-cardiology]

Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G., Coats, A. J., … & Van Der Meer, P. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J, 37(27), 2129-2200.