Dallas—Aggressive high blood pressure treatment is being promoted by a number of guidelines, but determining exactly which patients will benefit can be difficult. A new study seeks to remedy that by introducing an accurate prediction tool.

Published in the American Journal of Cardiology, a machine learning algorithm combines three variables routinely collected during clinic visits—patient age, urinary albumin/creatinine ratio (UACR), and cardiovascular disease history—to identify hypertensive patients for whom the benefits of intensive therapy outweigh risks.

“Large randomized trials have provided inconsistent evidence regarding the benefit of intensive blood pressure lowering in hypertensive patients,” said corresponding author Yang Xie, PhD, director of the Quantitative Biomedical Research Center at University of Texas Southwestern. “To the best of our knowledge, this is the first study to identify a subgroup of patients who derive a higher net benefit from intensive blood pressure treatment.”

Patient data came from two National Institutes of Health–funded randomized controlled trials that tested intensive versus standard blood pressure–lowering treatments—the Systolic Blood Pressure Intervention Trial (SPRINT), which included 9,361 nondiabetic hypertensive adults at an elevated risk of cardiovascular event, and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, which enrolled 10,251 patients with type 2 diabetes.

“I think our algorithm can help us identify high-risk patients who will most likely benefit from intensive blood pressure reduction. Long-term intensive HBP drug therapy can reduce risk of heart failure and death, but it carries an increased risk of side effects,” explained coauthor Wanpen Vongpatanasin, MD.

With the algorithm, patients who met one or more of the three criteria were predicted to be among a high-risk group who had a greater benefit from intensive blood pressure-lowering treatment. On the other hand, the study team determined that patients younger than age 74 years who had a UACR less than 34 and no history of cardiovascular disease might do as well with less intensive treatment.

The study notes that, compared with standard treatment, intensive BP lowering was associated with lower rates of major adverse cardiovascular events in this high-risk population in both SPRINT cross-validation data (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.52-0.85) and ACCORD (HR 0.67, 95% CI 0.50-0.90), but not in the remaining low-risk patients (SPRINT: HR 0.83, 95% CI 0.56-1.25; ACCORD: HR 1.09, 95% CI 0.64-1.83).

“Additionally, intensive BP lowering did not confer an excess risk of serious adverse events in the high-risk group,” researchers write.

“In conclusion, this simple risk prediction model consisting of age, urinary albumin-creatinine ratio, and clinical CVD history successfully identified a subset of hypertensive patients who derived a more favorable risk-benefit profile for intensive BP lowering,” study authors point out.

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