{"id":"c404368b077b","type":"article","url":"https://hartvaat.nl/2017/07/01/heterogeniteit-in-vroege-respons-op-antihypertensiva-allhat/","title":"Heterogeniteit in vroege respons op antihypertensiva: ALLHAT","title_en":"Heterogeneity in Early Responses in ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.09221","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.09221","authors":["Sanket S Dhruva","Chenxi Huang","Erica S Spatz","Andreas C Coppi","Frederick Warner","Shu-Xia Li","Haiqun Lin","Xiao Xu","Curt D Furberg","Barry R Davis","Sara L Pressel","Ronald R Coifman","Harlan M Krumholz"],"significance":6,"published":"2017-07-01","source_date":"2017-07-01","image":"","kennis":[],"congress":"","summary_en":"This ALLHAT analysis examined heterogeneity in early blood pressure responses to different antihypertensive classes, finding clinically meaningful variation that may guide personalized drug selection strategies.","created":"2026-07-03T10:26:46Z","updated":"2026-07-03T13:26:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ALLHAT-analyse die heterogeniteit in vroege bloeddrukrespons op verschillende antihypertensivaklassen onderzocht. Relevant voor gepersonaliseerde startkeuze.","abstract_original":"Randomized trials of hypertension have seldom examined heterogeneity in response to treatments over time and the implications for cardiovascular outcomes. Understanding this heterogeneity, however, is a necessary step toward personalizing antihypertensive therapy. We applied trajectory-based modeling to data on 39 763 study participants of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) to identify distinct patterns of systolic blood pressure (SBP) response to randomized medications during the first 6 months of the trial. Two trajectory patterns were identified: immediate responders (85.5%), on average, had a decreasing SBP, whereas nonimmediate responders (14.5%), on average, had an initially increasing SBP followed by a decrease. Compared with those randomized to chlorthalidone, participants randomized to amlodipine (odds ratio, 1.20; 95% confidence interval [CI], 1.10-1.31), lisinopril (odds ratio, 1.88; 95% CI, 1.73-2.03), and doxazosin (odds ratio, 1.65; 95% CI, 1.52-1.78) had higher adjusted odds ratios associated with being a nonimmediate responder (versus immediate responder). After multivariable adjustment, nonimmediate responders had a higher hazard ratio of stroke (hazard ratio, 1.49; 95% CI, 1.21-1.84), combined cardiovascular disease (hazard ratio, 1.21; 95% CI, 1.11-1.31), and heart failure (hazard ratio, 1.48; 95% CI, 1.24-1.78) during follow-up between 6 months and 2 years. The SBP response trajectories provided superior discrimination for predicting downstream adverse cardiovascular events than classification based on difference in SBP between the first 2 measurements, SBP at 6 months, and average SBP during the first 6 months. Our findings demonstrate heterogeneity in response to antihypertensive therapies and show that chlorthalidone is associated with more favorable initial response than the other medications."}