Incorporating Individual‐Level Treatment Effects and Outcome Preferences Into Personalized Blood Pressure Target Recommendations
Background There are no shared decision‐making frameworks for selecting blood pressure (BP) targets for individuals with hypertension. This study addressed whether results from the SPRINT (Systolic Blood Pressure Intervention Trial) could be tailored to individuals using predicted risks and simulate...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-08-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.033995 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846150772789608448 |
|---|---|
| author | Simon B. Ascher Richard L. Kravitz Rebecca Scherzer Jarett D. Berry James A. de Lemos Michelle M. Estrella Daniel J. Tancredi Anthony A. Killeen Joachim H. Ix Michael G. Shlipak |
| author_facet | Simon B. Ascher Richard L. Kravitz Rebecca Scherzer Jarett D. Berry James A. de Lemos Michelle M. Estrella Daniel J. Tancredi Anthony A. Killeen Joachim H. Ix Michael G. Shlipak |
| author_sort | Simon B. Ascher |
| collection | DOAJ |
| description | Background There are no shared decision‐making frameworks for selecting blood pressure (BP) targets for individuals with hypertension. This study addressed whether results from the SPRINT (Systolic Blood Pressure Intervention Trial) could be tailored to individuals using predicted risks and simulated preferences. Methods and Results Among 8202 SPRINT participants, Cox models were developed and internally validated to predict each individual's absolute difference in risk from intensive versus standard BP lowering for cardiovascular events, cognitive impairment, death, and serious adverse events (AEs). Individual treatment effects were combined using simulated preference weights into a net benefit, which represents a weighted sum of risk differences across outcomes. Net benefits were compared among those above versus below the median AE risk. In simulations for which cardiovascular, cognitive, and death events had much greater weight than the AEs of BP lowering, the median net benefit was 3.3 percentage points (interquartile range [IQR], 2.0–5.7), and 100% of participants had a net benefit favoring intensive BP lowering. When simulating benefits and harms to have similar weights, the median net benefit was 0.8 percentage points (IQR, 0.2–2.2), and 87% had a positive net benefit. Compared with participants at lower risk of AEs from BP lowering, those at higher risk had a greater net benefit from intensive BP lowering despite experiencing more AEs (P<0.001 in both simulations). Conclusions Most SPRINT participants had a predicted net benefit that favored intensive BP lowering, but the degree of net benefit varied considerably. Tailoring BP targets using each patient's risks and preferences may provide more refined BP target recommendations. |
| format | Article |
| id | doaj-art-be1b5e76a58f45fab32b44480a670c3b |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-be1b5e76a58f45fab32b44480a670c3b2024-11-28T09:27:28ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-08-01131610.1161/JAHA.124.033995Incorporating Individual‐Level Treatment Effects and Outcome Preferences Into Personalized Blood Pressure Target RecommendationsSimon B. Ascher0Richard L. Kravitz1Rebecca Scherzer2Jarett D. Berry3James A. de Lemos4Michelle M. Estrella5Daniel J. Tancredi6Anthony A. Killeen7Joachim H. Ix8Michael G. Shlipak9Department of Internal Medicine, Kidney Health Research Collaborative San Francisco Veterans Affairs Health Care System and University of California San Francisco San Francisco CADepartment of Internal Medicine University of California Davis Sacramento CADepartment of Internal Medicine, Kidney Health Research Collaborative San Francisco Veterans Affairs Health Care System and University of California San Francisco San Francisco CADepartment of Internal Medicine University of Texas at Tyler Health Science Center Tyler TXDivision of Cardiology, Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TXDepartment of Internal Medicine, Kidney Health Research Collaborative San Francisco Veterans Affairs Health Care System and University of California San Francisco San Francisco CADepartment of Pediatrics University of California Davis Sacramento CADepartment of Laboratory Medicine and Pathology University of Minnesota Minneapolis MNDivision of Nephrology‐Hypertension University of California San Diego La Jolla CADepartment of Internal Medicine, Kidney Health Research Collaborative San Francisco Veterans Affairs Health Care System and University of California San Francisco San Francisco CABackground There are no shared decision‐making frameworks for selecting blood pressure (BP) targets for individuals with hypertension. This study addressed whether results from the SPRINT (Systolic Blood Pressure Intervention Trial) could be tailored to individuals using predicted risks and simulated preferences. Methods and Results Among 8202 SPRINT participants, Cox models were developed and internally validated to predict each individual's absolute difference in risk from intensive versus standard BP lowering for cardiovascular events, cognitive impairment, death, and serious adverse events (AEs). Individual treatment effects were combined using simulated preference weights into a net benefit, which represents a weighted sum of risk differences across outcomes. Net benefits were compared among those above versus below the median AE risk. In simulations for which cardiovascular, cognitive, and death events had much greater weight than the AEs of BP lowering, the median net benefit was 3.3 percentage points (interquartile range [IQR], 2.0–5.7), and 100% of participants had a net benefit favoring intensive BP lowering. When simulating benefits and harms to have similar weights, the median net benefit was 0.8 percentage points (IQR, 0.2–2.2), and 87% had a positive net benefit. Compared with participants at lower risk of AEs from BP lowering, those at higher risk had a greater net benefit from intensive BP lowering despite experiencing more AEs (P<0.001 in both simulations). Conclusions Most SPRINT participants had a predicted net benefit that favored intensive BP lowering, but the degree of net benefit varied considerably. Tailoring BP targets using each patient's risks and preferences may provide more refined BP target recommendations.https://www.ahajournals.org/doi/10.1161/JAHA.124.033995hypertensionpatient preferencesprecision medicinepredictionshared decision‐making |
| spellingShingle | Simon B. Ascher Richard L. Kravitz Rebecca Scherzer Jarett D. Berry James A. de Lemos Michelle M. Estrella Daniel J. Tancredi Anthony A. Killeen Joachim H. Ix Michael G. Shlipak Incorporating Individual‐Level Treatment Effects and Outcome Preferences Into Personalized Blood Pressure Target Recommendations Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease hypertension patient preferences precision medicine prediction shared decision‐making |
| title | Incorporating Individual‐Level Treatment Effects and Outcome Preferences Into Personalized Blood Pressure Target Recommendations |
| title_full | Incorporating Individual‐Level Treatment Effects and Outcome Preferences Into Personalized Blood Pressure Target Recommendations |
| title_fullStr | Incorporating Individual‐Level Treatment Effects and Outcome Preferences Into Personalized Blood Pressure Target Recommendations |
| title_full_unstemmed | Incorporating Individual‐Level Treatment Effects and Outcome Preferences Into Personalized Blood Pressure Target Recommendations |
| title_short | Incorporating Individual‐Level Treatment Effects and Outcome Preferences Into Personalized Blood Pressure Target Recommendations |
| title_sort | incorporating individual level treatment effects and outcome preferences into personalized blood pressure target recommendations |
| topic | hypertension patient preferences precision medicine prediction shared decision‐making |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.033995 |
| work_keys_str_mv | AT simonbascher incorporatingindividualleveltreatmenteffectsandoutcomepreferencesintopersonalizedbloodpressuretargetrecommendations AT richardlkravitz incorporatingindividualleveltreatmenteffectsandoutcomepreferencesintopersonalizedbloodpressuretargetrecommendations AT rebeccascherzer incorporatingindividualleveltreatmenteffectsandoutcomepreferencesintopersonalizedbloodpressuretargetrecommendations AT jarettdberry incorporatingindividualleveltreatmenteffectsandoutcomepreferencesintopersonalizedbloodpressuretargetrecommendations AT jamesadelemos incorporatingindividualleveltreatmenteffectsandoutcomepreferencesintopersonalizedbloodpressuretargetrecommendations AT michellemestrella incorporatingindividualleveltreatmenteffectsandoutcomepreferencesintopersonalizedbloodpressuretargetrecommendations AT danieljtancredi incorporatingindividualleveltreatmenteffectsandoutcomepreferencesintopersonalizedbloodpressuretargetrecommendations AT anthonyakilleen incorporatingindividualleveltreatmenteffectsandoutcomepreferencesintopersonalizedbloodpressuretargetrecommendations AT joachimhix incorporatingindividualleveltreatmenteffectsandoutcomepreferencesintopersonalizedbloodpressuretargetrecommendations AT michaelgshlipak incorporatingindividualleveltreatmenteffectsandoutcomepreferencesintopersonalizedbloodpressuretargetrecommendations |