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Methods to estimate underlying blood pressure: The Atherosclerosis Risk in Communities (ARIC) Study.

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Summary

Estimating untreated blood pressure (BP) is crucial for natural history studies. Simple constant addition methods accurately estimate underlying BP and its longitudinal associations with age.

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Area of Science:

  • Epidemiology
  • Biostatistics
  • Cardiovascular Research

Background:

  • Antihypertensive medications interfere with natural history studies of blood pressure (BP).
  • Accurate estimation of untreated, or underlying, BP is essential for valid research.
  • Previous imputation methods for missing BP data have limitations in longitudinal studies.

Purpose of the Study:

  • To compare the validity of five distinct imputation methods for estimating underlying BP.
  • To assess the longitudinal associations between estimated underlying BP and age.
  • To determine the most accurate method for reconstructing BP trajectories in treated hypertensive individuals.

Main Methods:

  • Simulated BP treatment in untreated participants from the ARIC cohort using matched treated individuals.
  • Imputed underlying BP using five methods: missing data, constant addition (systolic/diastolic), medication-specific constant, truncated normal regression, and regression with prior visit data.
  • Estimated longitudinal associations using linear mixed models comparing imputed underlying BP and measured BP.

Main Results:

  • Medication class-specific constant addition (Method 3) showed the lowest relative bias and deviation for systolic BP.
  • Simple constant addition (10 mmHg systolic, 5 mmHg diastolic; Method 2) performed best for diastolic BP.
  • Truncated normal regression methods were comparable or slightly inferior to constant addition methods.

Conclusions:

  • Constant addition imputation methods provide valid and precise estimates of underlying BP.
  • These methods effectively capture longitudinal associations between underlying BP and age.
  • Simple imputation techniques are recommended for estimating underlying BP in longitudinal studies complicated by antihypertensive treatment.