Machine Learning–Based Prediction for Incident Hypertension Based on Regular Health Checkup Data: Derivation and Validation in 2 Independent Nationwide Cohorts in South Korea and Japan

Abstract

Background Worldwide, cardiovascular diseases are the primary cause of death, with hypertension as a key contributor. In 2019, cardiovascular diseases led to 17.9 million deaths, predicted to reach 23 million by 2030. Objective This study presents a new method to predict hypertension using demographic data, using 6 machine learning models for enhanced reliability and applicability. The goal is to harness artificial intelligence for early and accurate hypertension diagnosis across diverse populations. Methods Data from 2 national cohort studies, National Health Insurance Service-National Sample Cohort (South Korea, n=244,814), conducted between 2002 and 2013 were used to train and test machine learning models designed to anticipate incident hypertension within 5 years of a health checkup involving those aged ≥20 years, and Japanese Medical Data Center cohort (Japan, n=1,296,649) were used for extra validation. An ensemble from 6 diverse machine learning models was used to identify the 5 most salient features contributing to hypertension by presenting a feature importance analysis to confirm the contribution of each future. Results The Adaptive Boosting and logistic regression ensemble showed superior balanced accuracy (0.812, sensitivity 0.806, specificity 0.818, and area under the receiver operating characteristic curve 0.901). The 5 key hypertension indicators were age, diastolic blood pressure, BMI, systolic blood pressure, and fasting blood glucose. The Japanese Medical Data Center cohort dataset (extra validation set) corroborated these findings (balanced accuracy 0.741 and area under the receiver operating characteristic curve 0.824). The ensemble model was integrated into a public web portal for predicting hypertension onset based on health checkup data. Conclusions Comparative evaluation of our machine learning models against classical statistical models across 2 distinct studies emphasized the former’s enhanced stability, generalizability, and reproducibility in predicting hypertension onset.