Background: Prior randomized trials of hypertension have rarely examined patient heterogeneity in response to treatments and the implications for outcomes. Methods: We applied growth mixture modeling to identify distinct SBP trajectory classes within the first 6 months of ALLHAT. We assessed the effect of treatment associated with membership in a particular trajectory class. Difference in incidence of combined cardiovascular disease (CCVD) between the trajectory classes was compared using log-rank test and cox proportional hazard models. Results: The optimal model classified patients into two distinct trajectory classes. Class 1, 5785 (14.5%) patients, had a baseline mean SBP of 154 mmHg which increased by 7.8 mmHg within the first month, and then decreased (Figure). Class 2, 33,978 (85.5%) patients, had a baseline mean SBP of 145 mmHg which declined by 4.8 mmHg within the first month and then leveled off. Compared to those randomized to chlorthalidone, the odds of being in Class 1 was higher for participants randomized to amlodipine (OR 1.18; 95% CI, 1.09- 1.28), lisinopril (OR 1.79; 95% CI, 1.66-1.93), and doxazosin (OR 1.58; 95% CI, 1.47-1.71). Class 1 participants had higher 6-month CCVD incidence after adjustment for baseline BP, demographics, comorbidities, and 6-month adherence (HR 1.21; 95% CI, 1.07-1.37). Conclusions: There is heterogeneity in response to initiation of antihypertensive therapies. Different response patterns are associated with different risk for cardiovascular events. (Figure Presented).
Dhruva, S. S., Huang, C., Spatz, E., Coppi, A., Warner, F., Li, S.-X., … Krumholz, H. (2017). TOWARD IDENTIFYING PERSONALIZED PROGNOSIS IN HYPERTENSION: VARIATION IN EARLY RESPONSES IN THE ANTIHYPERTENSIVE AND LIPID-LOWERING TREATMENT TO PREVENT HEART ATTACK TRIAL (ALLHAT). Journal of the American College of Cardiology, 69(11), 1762. https://doi.org/10.1016/s0735-1097(17)35151-3