TY - JOUR
T1 - Trajectories of Blood Pressure Control a Year after Randomization and Incident Cardiovascular Outcomes in SPRINT
AU - German, Charles A.
AU - Elfassy, Tali
AU - Singleton, Matthew J.
AU - Rodriguez, Carlos J.
AU - Ambrosius, Walter T.
AU - Yeboah, Joseph
N1 - Publisher Copyright:
© 2021 American Journal of Hypertension, Ltd 2021. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - BACKGROUND: While studies have assessed the association between blood pressure trajectories and cardiovascular disease (CVD) outcomes using observational data, few have assessed these associations using clinical trial data. We sought to identify systolic blood pressure (SBP) trajectories and to determine if these trajectory patterns carry inherent CVD risk, irrespective of baseline blood pressure. METHODS: SBP trajectories were identified using latent class group-based modeling among a cohort of Systolic Blood Pressure Intervention Trial (SPRINT) participants by incorporating SBP measures during the first 12 months of the trial postrandomization. Cox models were used to evaluate the association between SBP trajectory with CVD and all-cause mortality. RESULTS: Four distinct SBP trajectories were identified: "low decline"(41%), "high decline"(6%), "low stable"(48%), and "high stable"(5%). Relative to the "low decline"group, the "low stable"group was associated with a 29% increased risk of CVD (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.06-1.57) and the "high stable"group was associated with a 76% increased risk of all-cause mortality (HR: 1.76, 95% CI: 1.15-2.68). Relative to the "low stable"group, the "high stable"group was associated with a 54% increased risk of all-cause mortality (HR: 1.54, 95% CI: 1.05-2.28). CONCLUSIONS: Our results demonstrate that SBP trajectory patterns are associated with important cardiovascular outcomes, irrespective of baseline blood pressure, which may help better identify individuals at risk and assist with accurate adjudication of antihypertensive therapy to reduce future events.
AB - BACKGROUND: While studies have assessed the association between blood pressure trajectories and cardiovascular disease (CVD) outcomes using observational data, few have assessed these associations using clinical trial data. We sought to identify systolic blood pressure (SBP) trajectories and to determine if these trajectory patterns carry inherent CVD risk, irrespective of baseline blood pressure. METHODS: SBP trajectories were identified using latent class group-based modeling among a cohort of Systolic Blood Pressure Intervention Trial (SPRINT) participants by incorporating SBP measures during the first 12 months of the trial postrandomization. Cox models were used to evaluate the association between SBP trajectory with CVD and all-cause mortality. RESULTS: Four distinct SBP trajectories were identified: "low decline"(41%), "high decline"(6%), "low stable"(48%), and "high stable"(5%). Relative to the "low decline"group, the "low stable"group was associated with a 29% increased risk of CVD (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.06-1.57) and the "high stable"group was associated with a 76% increased risk of all-cause mortality (HR: 1.76, 95% CI: 1.15-2.68). Relative to the "low stable"group, the "high stable"group was associated with a 54% increased risk of all-cause mortality (HR: 1.54, 95% CI: 1.05-2.28). CONCLUSIONS: Our results demonstrate that SBP trajectory patterns are associated with important cardiovascular outcomes, irrespective of baseline blood pressure, which may help better identify individuals at risk and assist with accurate adjudication of antihypertensive therapy to reduce future events.
KW - SPRINT
KW - blood pressure
KW - cardiovascular disease
KW - hypertension
KW - prevention
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U2 - 10.1093/ajh/hpab059
DO - 10.1093/ajh/hpab059
M3 - Article
C2 - 33861306
AN - SCOPUS:85117329573
SN - 0895-7061
VL - 34
SP - 973
EP - 980
JO - American journal of hypertension
JF - American journal of hypertension
IS - 9
ER -