Mid- to Late-Life Trajectories of Blood Pressure and the Risk of Stroke

Portegies, Marileen L.P.; Mirza, Saira Saeed; Verlinden, Vincentius J.A.; Hofman, Albert; Koudstaal, Peter J.; Swanson, Sonja A.; Ikram, M. Arfan

doi:10.1161/hypertensionaha.116.07098

Cited by 53 publications

(54 citation statements)

References 45 publications

(46 reference statements)

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“…Previous observational studies have shown that trajectories of rising BP are associated with adverse clinical cardiovascular outcomes 35,36 ; our findings extend these by including the role of antihypertensive medications.…”

Section: Hypertensionsupporting

confidence: 81%

Heterogeneity in Early Responses in ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial)

et al. 2017

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Abstract-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 provided superior discrimination for predicting downstream adverse cardiovascular events than classification based on difference in SBP between the first 2 measurements, SBP at 6 months, and average SBP during the first 6 months. Our findings demonstrate heterogeneity in response to antihypertensive therapies and show that chlorthalidone is associated with more favorable initial response than the other medications. (Hypertension. 2017;70:94-102.

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Section: Hypertensionsupporting

confidence: 81%

Heterogeneity in Early Responses in ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial)

et al. 2017

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“…The average of three BP values was used in the analyses. A Hawksley random zero sphygmomanometer was used 14 for the first six visits, and an Omron M6 (Omron, Kyoto, Japan) device was used 15 in 2017 for BP measurements by trained and certified staff. An appropriate cuff size was used, and the procedure was performed in a quiet and comfortable environment.…”

Section: Bp Measurementsmentioning

confidence: 99%

Association of Blood Pressure Trajectories in Early Life with Subclinical Renal Damage in Middle Age

Zheng

Chu

et al. 2018

JASN

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Background Although high BP is one of the most important factors affecting renal function, whether longitudinal BP trajectories in early life course are associated with renal function damage in later life is unclear.Methods To investigate the correlation between BP trajectories from childhood to adulthood and renal function in middle age, we used group-based trajectory models to identify BP trajectories in 2430 individuals (aged 6-15 years old at baseline) participating in the ongoing Hanzhong Adolescent Hypertension Cohort. We tested the association between these trajectories and subclinical renal damage in middle age, adjusting for several covariates. ResultsWe identified four distinct systolic BP trajectories among 2430 subjects: low stable, moderate stable, high stable, and moderate increasing on the basis of systolic BP levels at baseline and during the 30-year follow-up period. The urinary albumin-to-creatinine ratio (uACR) was higher in moderate stable, high stable, and moderate increasing groups compared with the low stable group. A total of 228 individuals had subclinical renal disease by 2017. Compared with the low stable trajectory group, the other groups had increasingly greater odds of experiencing subclinical renal disease in middle age. These associations were not altered after adjustment for other covariates, except for in the moderate stable group. Analyzed results were similar for the mean arterial pressure and diastolic BP trajectory groups.Conclusions Higher BP trajectories were correlated with higher of uACR levels and risk of subclinical renal disease in middle age. Identifying long-term BP trajectories from early age may assist in predicting individuals' renal function in later life.

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“…Recent longitudinal studies suggest that there may be subgroups with distinct BP trajectories, which are associated with clinical outcomes, among relatively healthy persons in the general population to high-risk persons, such as those with newly diagnosed coronary heart disease, with subclinical atherosclerosis, or >80 years of age. [3][4][5][6][7][8] Subgrouping by BP trajectories has been estimated during a protracted time period, to help control for factors such as acute psychological stress or circadian variation. However, a sufficiently large sample size may dampen such noise.…”

mentioning

confidence: 99%

Trajectory Groups of 24-Hour Systolic Blood Pressure After Acute Ischemic Stroke and Recurrent Vascular Events

Kim

Cho

Hong

et al. 2018

Stroke

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Blood pressure (BP) is an important modifiable risk factor for stroke and may have prognostic significance after acute ischemic stroke (AIS).1 BP has been treated as a mean measure or variability index and in either case is associated with stroke outcomes. 2 Less well elucidated, however, are patterns of BP changes during a certain period of time, which Background and Purpose-Blood pressure dynamics in patients with acute ischemic stroke may serve as an important modifiable and prognostic factor. Methods-A total of 8376 patients with acute ischemic stroke were studied from a prospective multicenter registry. Patients were eligible if they had been admitted within 24 hours of symptom onset and had ≥5 systolic blood pressure (SBP) measurements during the first 24 hours of hospitalization. SBP trajectory groups in the first 24 hours were identified using the TRAJ procedure in SAS software with delta-Bayesian Information Criterion and prespecified modeling parameters. Vascular events, including recurrent stroke, myocardial infarction, and death, were prospectively collected. The risk of having vascular events was calculated using the frailty model to adjust for clustering by hospital. Results-The group-based trajectory model classified patients with acute ischemic stroke into 5 SBP trajectory groups: low (22.3%), moderate (40.8%), rapidly stabilized (11.9%), acutely elevated (18.5%), and persistently high (6.4%) SBP. The risk of having vascular events was increased in the acutely elevated (hazard ratio, 1.28 [95% confidence interval, 1.12-1.47]) and the persistently high SBP groups (hazard ratio, 1.67 [95% confidence interval, 1.37-2.04]) but not in the rapidly stabilized group (hazard ratio, 1.13 [95% confidence interval, 0.95-1.34]), when compared with the moderate SBP group. Conclusions-SBP during the first 24 hours after acute ischemic stroke may be categorized into distinct trajectory groups, which differ in relation to stroke characteristics and frequency of subsequent recurrent vascular event risks. The findings may help to recognize potential candidates for future blood pressure control trials.

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Mid- to Late-Life Trajectories of Blood Pressure and the Risk of Stroke

Cited by 53 publications

References 45 publications

Heterogeneity in Early Responses in ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial)

Heterogeneity in Early Responses in ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial)

Association of Blood Pressure Trajectories in Early Life with Subclinical Renal Damage in Middle Age

Trajectory Groups of 24-Hour Systolic Blood Pressure After Acute Ischemic Stroke and Recurrent Vascular Events

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