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Potential of Stratified Medicine for High Blood Pressure Management: A Modeling Study Using NHANES Survey Data

Raphaël Porcher1,2,3, Viet-Thi Tran1,2, Jacques Blacher3,4,5

  • 1From the Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Hôtel-Dieu, Center for Clinical Epidemiology, Paris, France (R.P., V.-T.T., P.R.).

Hypertension (Dallas, Tex. : 1979)
|November 5, 2019
PubMed

Insights

Personalizing intensive hypertension treatment can significantly reduce harms. A stratified medicine approach spares over half of individuals from treatment while minimizing adverse events, offering a more tailored approach to cardiovascular care.

Area of Science:

  • Cardiology
  • Public Health
  • Pharmacogenomics

Background:

  • The 2017 ACC/AHA hypertension guidelines lowered treatment thresholds.
  • The SPRINT trial indicated patient-specific benefits and harms of intensive treatment.
  • Individual patient characteristics influence the risk-benefit profile of antihypertensive therapies.

Purpose of the Study:

  • To evaluate the potential benefits of personalizing intensive antihypertensive treatment.
  • To compare universal treatment based on 2017 guidelines versus a stratified medicine approach.
  • To quantify gains in preventing cardiovascular events and reducing severe adverse events through personalized treatment.

Main Methods:

  • Utilized data from the US National Health and Nutrition Examination Survey (2011-2014).
  • Applied prediction models from the SPRINT trial to estimate outcomes for individuals aged 50+.
  • Compared a universal treatment strategy against a stratified approach excluding patients with unfavorable predicted benefit-risk.

Main Results:

  • Under 2017 guidelines, 40.1 million US adults aged 50+ require intensified antihypertensive treatment.
  • This universal approach could prevent 795,000 cardiovascular events but cause 848,000 severe adverse events over 5 years.
  • A stratified strategy could reduce the number of individuals treated by 52.9% and severe adverse events by 38.3%, with 11.7% fewer cardiovascular events prevented.

Conclusions:

  • Personalizing intensive antihypertensive treatment based on predicted benefits and harms can spare over half of individuals from treatment.
  • This approach significantly reduces severe adverse events (3x more than benefits prevented).
  • Stratified medicine offers a more tailored and safer strategy for managing hypertension in older adults.

Keywords:
blood pressurecardiologydecision support techniqueshypertensionmodels, statistical

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