Hypertension, high blood pressure (BP), is a common condition in which the force of blood against the artery wall is high that may cause heart diseases. Hypertension affects approximately 1 billion adults worldwide. The level of BP is used to classify the severity of hypertension and to determine the treatment goal (i.e., target BP level). The threshold of above measurements have changed over time. Following recent changes in guidelines1, more patients will initiate medications, and will be prescribed with lower target BP levels. However, some aspects of guidelines are only supported by expert opinion, without supporting clinical evidence. Therefore, it is important to generate related evidence using real-world data. To facilitate the practice of personalized medicine, we will identify a BP control plan using the Clinical Practice Research Datalink. All patients who initiated any antihypertensive therapy between 1998 and 2017 will be included. We will first describe the treatment pattern over time and compare the rate of heart diseases within each treatment pattern. We will investigate whether targeting a lower BP level delays and prevents more events of heart diseases compared with higher BP level for treatment-naive patients at low risk. Finally, a personalized BP control plan will be identified.
The level of BP is used to classify the severity of hypertension and to determine treatment goals (i.e., target BP level), both of which have changed over time. Treatment guidelines were recently revised to incorporate the results from two large randomized controlled trials (RCTs), ACCORD2 and SPRINT3. However, those studies failed to investigate the beneficial target BP level for patients at low cardiovascular (CVD) risk. Therefore, it is urgent to investigate the benefits of tight BP control among patients at low CVD risk and generate a personalized dynamic BP control plan for such patients. We will conduct a retrospective, population-based cohort study. We will identify all hypertensive patients with no previous history of CVD events who initiated an antihypertensive prescription from 1998-2018. Treatment patterns will be generated from class level (i.e., thiazide diuretics, angiotensin-converting-enzyme inhibitors). We will assign each patient to follow different BP control plans. The time to event hazard (i.e., major cardiovascular event, major coronary disease event, death from any cause) will be compared among different plans. Dynamic marginal structural modelling45 and inverse-intensity-rate-ratio weight will be applied to solve time-dependent confounders and covariate-dependent follow-ups, respectively.
Major cardiovascular event (nonfatal myocardial infarction (MI), nonfatal stroke, or cardiovascular disease caused death)
- Expanded macrovascular event (nonfatal MI, nonfatal stroke, cardiovascular disease caused death, revascularization or hospitalization for congestive heart failure)
- Major coronary disease events (fatal coronary event, nonfatal MI, hospitalization for angina)
- MI (fatal and nonfatal)
- Total stroke (fatal and nonfatal)
- Death from any cause
- Cardiovascular disease (CVD) mortality
- Hospitalization or death due to congestive heart failure
- Severe adverse event related to antihypertensive treatment (such as hypotension, syncope, electrolyte abnormalities, bradycardia, and acute kidney injury or failure, which caused ER visits, hospitalizations, or reported in the routine visit)
- Lab values (systolic blood pressure [SBP], diastolic blood pressure [DBP], haemoglobin A1c [HbA1c], creatinine level)
- Anti-hypertensive medications
Samy Suissa - Chief Investigator - Sir Mortimer B Davis Jewish General Hospital
Robert Platt - Corresponding Applicant - McGill University
Antonios Douros - Collaborator - McGill University
Christopher Filliter - Collaborator - Sir Mortimer B Davis Jewish General Hospital
Kristian Filion - Collaborator - McGill University
pauline reynier - Collaborator - Sir Mortimer B Davis Jewish General Hospital
Qi Zhang - Collaborator - Sir Mortimer B Davis Jewish General Hospital
Shahrzad Salmasi - Collaborator - IQVIA Canada
Tianze Jiao - Collaborator - University of Florida
Shahrzad Salmasi - Collaborator - McGill University
Tianze Jiao - Collaborator - McGill University
HES Admitted Patient Care;ONS Death Registration Data;Practice Level Index of Multiple Deprivation