Heterogeneity in Early Responses in ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial)Novelty and Significance [Clinical Trials]
Randomized trials of hypertension have seldom examined heterogeneity in response to treatments over time and the implications for cardiovascular outcomes. Understanding this heterogeneity, however, is a necessary step toward personalizing antihypertensive therapy. We applied trajectory-based modeling to data on 39 763 study participants of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) to identify distinct patterns of systolic blood pressure (SBP) response to randomized medications during the first 6 months of the trial. Two trajectory patterns were identified: immediate responders (85.5%), on average, had a decreasing SBP, whereas nonimmediate responders (14.5%), on average, had an initially increasing SBP followed by a decrease. Compared with those randomized to chlorthalidone, participants randomized to amlodipine (odds ratio, 1.20; 95% confidence interval [CI], 1.10–1.31), lisinopril (odds ratio, 1.88; 95% CI, 1.73–2.03), and doxazosin (odds ratio, 1.65; 95% CI, 1.52–1.78) had higher adjusted odds ratios associated with being a nonimmediate responder (versus immediate responder). After multivariable adjustment, nonimmediate responders had a higher hazard ratio of stroke (hazard ratio, 1.49; 95% CI, 1.21–1.84), combined cardiovascular disease (hazard ratio, 1.21; 95% CI, 1.11–1.31), and heart failure (hazard ratio, 1.48; 95% CI, 1.24–1.78) during follow-up between 6 months and 2 years. The SBP response trajectories pr...
Source: Hypertension - Category: Cardiology Authors: Sanket S. Dhruva, Chenxi Huang, Erica S. Spatz, Andreas C. Coppi, Frederick Warner, Shu-Xia Li, Haiqun Lin, Xiao Xu, Curt D. Furberg, Barry R. Davis, Sara L. Pressel, Ronald R. Coifman, Harlan M. Krumholz Tags: Cardiovascular Disease, Hypertension, Quality and Outcomes Original Articles Source Type: research
More News: Cardiology | Cardiovascular | Clinical Trials | Doxazosin | Heart | Heart Attack | Heart Failure | Hypertension | Lisinopril | Norvasc | Stroke | Study