Phenomapping of subgroups in hypertensive patients using unsupervised data-driven cluster analysis: An exploratory study of the SPRINT trial.

Pubmed ID: 31213079

Journal: European journal of preventive cardiology

Publication Date: Nov. 1, 2019

MeSH Terms: Humans, Male, Female, Aged, Risk Factors, Middle Aged, Hypertension, Treatment Outcome, Blood Pressure, Antihypertensive Agents, Phenotype, Decision Making

Authors: Yang DY, Nie ZQ, Liao LZ, Zhang SZ, Zhou HM, Sun XT, Zhong XB, Du ZM, Zhuang XD, Liao XX

Cite As: Yang DY, Nie ZQ, Liao LZ, Zhang SZ, Zhou HM, Sun XT, Zhong XB, Du ZM, Zhuang XD, Liao XX. Phenomapping of subgroups in hypertensive patients using unsupervised data-driven cluster analysis: An exploratory study of the SPRINT trial. Eur J Prev Cardiol 2019 Nov;26(16):1693-1706. Epub 2019 Jun 18.

Studies:

Abstract

BACKGROUND: Hypertensive patients are highly heterogeneous in cardiovascular prognosis and treatment responses. A better classification system with phenomapping of clinical features would be of greater value to identify patients at higher risk of developing cardiovascular outcomes and direct individual decision-making for antihypertensive treatment. METHODS: An unsupervised, data-driven cluster analysis was performed for all baseline variables related to cardiovascular outcomes and treatment responses in subjects from the Systolic Blood Pressure Intervention Trial (SPRINT), in order to identify distinct subgroups with maximal within-group similarities and between-group differences. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for cardiovascular outcomes and compare the effect of intensive antihypertensive treatment in different clusters. RESULTS: Four replicable clusters of patients were identified: cluster 1 (index hypertensives); cluster 2 (chronic kidney disease hypertensives); cluster 3 (obese hypertensives) and cluster 4 (extra risky hypertensives). In terms of prognosis, individuals in cluster 4 had the highest risk of developing primary outcomes. In terms of treatment responses, intensive antihypertensive treatment was shown to be beneficial only in cluster 4 (HR 0.73, 95% CI 0.55-0.98) and cluster 1 (HR 0.54, 95% CI 0.37-0.79) and was associated with an increased risk of severe adverse effects in cluster 2 (HR 1.18, 95% CI 1.05-1.32). CONCLUSION: Using a data-driven approach, SPRINT subjects can be stratified into four phenotypically distinct subgroups with different profiles on cardiovascular prognoses and responses to intensive antihypertensive treatment. Of note, these results should be taken as hypothesis generating that warrant further validation in future prospective studies.