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Armstrong ND, Srinivasasainagendra V, Chekka LMS, Nguyen NHK, Nahid NA, Jones AC, Tanner RM, Hidalgo BA, Limdi NA, Claas SA, Gong Y, McDonough CW, Cooper-DeHoff RM, Johnson JA, Tiwari HK, Arnett DK, Irvin MR. Genetic Contributors of Efficacy and Adverse Metabolic Effects of Chlorthalidone in African Americans from the Genetics of Hypertension Associated Treatments (GenHAT) Study. Genes (Basel) 2022; 13:genes13071260. [PMID: 35886043 PMCID: PMC9319619 DOI: 10.3390/genes13071260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 02/05/2023] Open
Abstract
Hypertension is a leading risk factor for cardiovascular disease mortality. African Americans (AAs) have the highest prevalence of hypertension in the United States, and to alleviate the burden of hypertension in this population, better control of blood pressure (BP) is needed. Previous studies have shown considerable interpersonal differences in BP response to antihypertensive treatment, suggesting a genetic component. Utilizing data from 4297 AA participants randomized to chlorthalidone from the Genetics of Hypertension Associated Treatments (GenHAT) study, we aimed to identify variants associated with the efficacy of chlorthalidone. An additional aim was to find variants that contributed to changes in fasting glucose (FG) in these individuals. We performed genome-wide association analyses on the change of systolic and diastolic BP (SBP and DBP) over six months and FG levels over 24 months of treatment. We sought replication in the International Consortia of Pharmacogenomics Studies. We identified eight variants statistically associated with BP response and nine variants associated with FG response. One suggestive LINC02211-CDH9 intergenic variant was marginally replicated with the same direction of effect. Given the impact of hypertension in AAs, this study implies that understanding the genetic background for BP control and glucose changes during chlorthalidone treatment may help prevent adverse cardiovascular events in this population.
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Affiliation(s)
- Nicole D Armstrong
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | - Lakshmi Manasa S Chekka
- Division of Applied Regulatory Sciences, Center for Drug Evaluation and Research, Silver Spring, MD 20903, USA
| | - Nam H K Nguyen
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA
| | - Noor A Nahid
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA
| | - Alana C Jones
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Rikki M Tanner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Bertha A Hidalgo
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Nita A Limdi
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Steven A Claas
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY 40506, USA
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA
| | - Caitrin W McDonough
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Hemant K Tiwari
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Donna K Arnett
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY 40506, USA
- Deans Office, College of Public Health, University of Kentucky, Lexington, KY 40506, USA
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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12
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Dhruva SS, Huang C, Spatz ES, Coppi AC, Warner F, Li SX, Lin H, Xu X, Furberg CD, Davis BR, Pressel SL, Coifman RR, Krumholz HM. Heterogeneity in Early Responses in ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial). Hypertension 2017; 70:94-102. [PMID: 28559399 DOI: 10.1161/hypertensionaha.117.09221] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 02/17/2017] [Accepted: 03/13/2017] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Sanket S Dhruva
- From the Robert Wood Johnson Foundation Clinical Scholars Program (S.S.D., H.M.K.), Section of Cardiovascular Medicine (E.S.S., A.C.C., F.W., H.M.K.), Department of Internal Medicine, and Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Yale School of Medicine, New Haven, CT; Department of Biostatistics (H.L.) and Section of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; Department of Mathematics, Yale University, New Haven, CT (R.R.C.); The Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.H., E.S.S., A.C.C., F.W., S.-X.L., X.X., H.M.K.); Veterans Affairs Connecticut Healthcare System, West Haven (S.S.D.); Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (C.D.F.); and University of Texas School of Public Health, Houston (B.R.D., S.L.P.)
| | - Chenxi Huang
- From the Robert Wood Johnson Foundation Clinical Scholars Program (S.S.D., H.M.K.), Section of Cardiovascular Medicine (E.S.S., A.C.C., F.W., H.M.K.), Department of Internal Medicine, and Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Yale School of Medicine, New Haven, CT; Department of Biostatistics (H.L.) and Section of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; Department of Mathematics, Yale University, New Haven, CT (R.R.C.); The Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.H., E.S.S., A.C.C., F.W., S.-X.L., X.X., H.M.K.); Veterans Affairs Connecticut Healthcare System, West Haven (S.S.D.); Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (C.D.F.); and University of Texas School of Public Health, Houston (B.R.D., S.L.P.)
| | - Erica S Spatz
- From the Robert Wood Johnson Foundation Clinical Scholars Program (S.S.D., H.M.K.), Section of Cardiovascular Medicine (E.S.S., A.C.C., F.W., H.M.K.), Department of Internal Medicine, and Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Yale School of Medicine, New Haven, CT; Department of Biostatistics (H.L.) and Section of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; Department of Mathematics, Yale University, New Haven, CT (R.R.C.); The Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.H., E.S.S., A.C.C., F.W., S.-X.L., X.X., H.M.K.); Veterans Affairs Connecticut Healthcare System, West Haven (S.S.D.); Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (C.D.F.); and University of Texas School of Public Health, Houston (B.R.D., S.L.P.)
| | - Andreas C Coppi
- From the Robert Wood Johnson Foundation Clinical Scholars Program (S.S.D., H.M.K.), Section of Cardiovascular Medicine (E.S.S., A.C.C., F.W., H.M.K.), Department of Internal Medicine, and Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Yale School of Medicine, New Haven, CT; Department of Biostatistics (H.L.) and Section of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; Department of Mathematics, Yale University, New Haven, CT (R.R.C.); The Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.H., E.S.S., A.C.C., F.W., S.-X.L., X.X., H.M.K.); Veterans Affairs Connecticut Healthcare System, West Haven (S.S.D.); Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (C.D.F.); and University of Texas School of Public Health, Houston (B.R.D., S.L.P.)
| | - Frederick Warner
- From the Robert Wood Johnson Foundation Clinical Scholars Program (S.S.D., H.M.K.), Section of Cardiovascular Medicine (E.S.S., A.C.C., F.W., H.M.K.), Department of Internal Medicine, and Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Yale School of Medicine, New Haven, CT; Department of Biostatistics (H.L.) and Section of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; Department of Mathematics, Yale University, New Haven, CT (R.R.C.); The Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.H., E.S.S., A.C.C., F.W., S.-X.L., X.X., H.M.K.); Veterans Affairs Connecticut Healthcare System, West Haven (S.S.D.); Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (C.D.F.); and University of Texas School of Public Health, Houston (B.R.D., S.L.P.)
| | - Shu-Xia Li
- From the Robert Wood Johnson Foundation Clinical Scholars Program (S.S.D., H.M.K.), Section of Cardiovascular Medicine (E.S.S., A.C.C., F.W., H.M.K.), Department of Internal Medicine, and Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Yale School of Medicine, New Haven, CT; Department of Biostatistics (H.L.) and Section of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; Department of Mathematics, Yale University, New Haven, CT (R.R.C.); The Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.H., E.S.S., A.C.C., F.W., S.-X.L., X.X., H.M.K.); Veterans Affairs Connecticut Healthcare System, West Haven (S.S.D.); Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (C.D.F.); and University of Texas School of Public Health, Houston (B.R.D., S.L.P.)
| | - Haiqun Lin
- From the Robert Wood Johnson Foundation Clinical Scholars Program (S.S.D., H.M.K.), Section of Cardiovascular Medicine (E.S.S., A.C.C., F.W., H.M.K.), Department of Internal Medicine, and Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Yale School of Medicine, New Haven, CT; Department of Biostatistics (H.L.) and Section of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; Department of Mathematics, Yale University, New Haven, CT (R.R.C.); The Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.H., E.S.S., A.C.C., F.W., S.-X.L., X.X., H.M.K.); Veterans Affairs Connecticut Healthcare System, West Haven (S.S.D.); Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (C.D.F.); and University of Texas School of Public Health, Houston (B.R.D., S.L.P.)
| | - Xiao Xu
- From the Robert Wood Johnson Foundation Clinical Scholars Program (S.S.D., H.M.K.), Section of Cardiovascular Medicine (E.S.S., A.C.C., F.W., H.M.K.), Department of Internal Medicine, and Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Yale School of Medicine, New Haven, CT; Department of Biostatistics (H.L.) and Section of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; Department of Mathematics, Yale University, New Haven, CT (R.R.C.); The Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.H., E.S.S., A.C.C., F.W., S.-X.L., X.X., H.M.K.); Veterans Affairs Connecticut Healthcare System, West Haven (S.S.D.); Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (C.D.F.); and University of Texas School of Public Health, Houston (B.R.D., S.L.P.)
| | - Curt D Furberg
- From the Robert Wood Johnson Foundation Clinical Scholars Program (S.S.D., H.M.K.), Section of Cardiovascular Medicine (E.S.S., A.C.C., F.W., H.M.K.), Department of Internal Medicine, and Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Yale School of Medicine, New Haven, CT; Department of Biostatistics (H.L.) and Section of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; Department of Mathematics, Yale University, New Haven, CT (R.R.C.); The Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.H., E.S.S., A.C.C., F.W., S.-X.L., X.X., H.M.K.); Veterans Affairs Connecticut Healthcare System, West Haven (S.S.D.); Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (C.D.F.); and University of Texas School of Public Health, Houston (B.R.D., S.L.P.)
| | - Barry R Davis
- From the Robert Wood Johnson Foundation Clinical Scholars Program (S.S.D., H.M.K.), Section of Cardiovascular Medicine (E.S.S., A.C.C., F.W., H.M.K.), Department of Internal Medicine, and Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Yale School of Medicine, New Haven, CT; Department of Biostatistics (H.L.) and Section of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; Department of Mathematics, Yale University, New Haven, CT (R.R.C.); The Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.H., E.S.S., A.C.C., F.W., S.-X.L., X.X., H.M.K.); Veterans Affairs Connecticut Healthcare System, West Haven (S.S.D.); Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (C.D.F.); and University of Texas School of Public Health, Houston (B.R.D., S.L.P.)
| | - Sara L Pressel
- From the Robert Wood Johnson Foundation Clinical Scholars Program (S.S.D., H.M.K.), Section of Cardiovascular Medicine (E.S.S., A.C.C., F.W., H.M.K.), Department of Internal Medicine, and Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Yale School of Medicine, New Haven, CT; Department of Biostatistics (H.L.) and Section of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; Department of Mathematics, Yale University, New Haven, CT (R.R.C.); The Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.H., E.S.S., A.C.C., F.W., S.-X.L., X.X., H.M.K.); Veterans Affairs Connecticut Healthcare System, West Haven (S.S.D.); Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (C.D.F.); and University of Texas School of Public Health, Houston (B.R.D., S.L.P.)
| | - Ronald R Coifman
- From the Robert Wood Johnson Foundation Clinical Scholars Program (S.S.D., H.M.K.), Section of Cardiovascular Medicine (E.S.S., A.C.C., F.W., H.M.K.), Department of Internal Medicine, and Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Yale School of Medicine, New Haven, CT; Department of Biostatistics (H.L.) and Section of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; Department of Mathematics, Yale University, New Haven, CT (R.R.C.); The Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.H., E.S.S., A.C.C., F.W., S.-X.L., X.X., H.M.K.); Veterans Affairs Connecticut Healthcare System, West Haven (S.S.D.); Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (C.D.F.); and University of Texas School of Public Health, Houston (B.R.D., S.L.P.)
| | - Harlan M Krumholz
- From the Robert Wood Johnson Foundation Clinical Scholars Program (S.S.D., H.M.K.), Section of Cardiovascular Medicine (E.S.S., A.C.C., F.W., H.M.K.), Department of Internal Medicine, and Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Yale School of Medicine, New Haven, CT; Department of Biostatistics (H.L.) and Section of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT; Department of Mathematics, Yale University, New Haven, CT (R.R.C.); The Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.H., E.S.S., A.C.C., F.W., S.-X.L., X.X., H.M.K.); Veterans Affairs Connecticut Healthcare System, West Haven (S.S.D.); Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (C.D.F.); and University of Texas School of Public Health, Houston (B.R.D., S.L.P.).
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