# Heterogeniteit in vroege respons op antihypertensiva: ALLHAT

*geplaatst 2017-07-01 · Cholesterol · Hypertension (Dallas, Tex. : 1979) · doi 10.1161/HYPERTENSIONAHA.117.09221 · https://hartvaat.nl/2017/07/01/heterogeniteit-in-vroege-respons-op-antihypertensiva-allhat/*

ALLHAT-analyse die heterogeniteit in vroege bloeddrukrespons op verschillende antihypertensivaklassen onderzocht. Relevant voor gepersonaliseerde startkeuze.

## English: Heterogeneity in Early Responses in ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: Hypertension (Dallas, Tex. : 1979), https://doi.org/10.1161/HYPERTENSIONAHA.117.09221. Bijgewerkt 2026-07-03T13:26:04Z. 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.