A personalized dynamic blood pressure control plan for patients with hypertension to maximize the delay of cardiovascular events

Date of Approval
Application Number
18_222
Technical Summary

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.

Health Outcomes to be Measured

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

Collaborators

Samy Suissa - Chief Investigator - McGill University
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 - McGill University
Tianze Jiao - Collaborator - University of Florida

Linkages

HES Admitted Patient Care;ONS Death Registration Data;Practice Level Index of Multiple Deprivation