Characteristics and clinical outcomes in malignant phase hypertension patients using cluster analysis: A report from the West Birmingham Malignant Hypertension Registry

IF 3.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Antonios A. Argyris , Alena Shantsila , Eduard Shantsila , D. Gareth Beevers , Gregory Y.  H. Lip
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Abstract

Purpose

Malignant hypertension (MHT) is a condition with high morbidity and mortality, necessitating a deeper understanding of its clinical heterogeneity for improved patient management. Aim of our study was to identify/characterize specific phenotypic groups and examine their associations with mortality.

Methods

Data from the West Birmingham MHT Registry were used. We performed two-step cluster analysis to determine distinct groups. Kaplan-Meier curves and Cox proportional hazard models were used to examine the associations of clusters with mortality.

Results

323 patients (mean age 49±13 years; 34 % female) with a median follow-up of 11 (IQR 3-18) years were included. Four clusters were identified; Cluster 1: younger age, intermediate prevalence of cardiovascular risk factors, high prevalence of renal/retinal damage; Cluster 2: older age, female, low prevalence of cardiovascular risk factors, intermediate levels of organ damage; Cluster 3: intermediate age, male, high prevalence of cardiovascular risk factors, high retinal damage; Cluster 4: younger age, male, low prevalence of cardiovascular risk factors, low prevalence of organ damage. In Kaplan Meier curves cluster 4 exhibited the lowest risk, while cluster 3 the highest risk for outcomes (log rank p < 0.001). In Cox regression, all clusters had higher risk of mortality compared to cluster 4; cluster 1 [HR 1.74 (1.07-2.82)], cluster 2 [HR 1.87 (1.20-2.91)], cluster 3 [HR 2.35 (1.54-3.58)].

Conclusions

Four distinct phenotypic clusters were identified within our registry, having diverse associations with mortality. These clusters offer a framework for more targeted risk stratification and prognostication, with implications for individualized patient care in this high-risk hypertensive population.
使用聚类分析的恶性期高血压患者的特征和临床结果:一份来自西伯明翰恶性高血压登记处的报告
恶性高血压(MHT)是一种高发病率和死亡率的疾病,需要深入了解其临床异质性,以改善患者管理。我们研究的目的是鉴定/表征特定表型组,并检查它们与死亡率的关系。方法使用来自西伯明翰MHT登记处的数据。我们进行了两步聚类分析来确定不同的组。Kaplan-Meier曲线和Cox比例风险模型用于检验聚类与死亡率的关系。结果323例患者(平均年龄49±13岁;34%为女性),中位随访时间为11年(IQR 3-18)。确定了四组;第一类:年龄较小,心血管危险因素患病率中等,肾/视网膜损伤患病率高;第二组:年龄较大,女性,心血管危险因素患病率低,器官损害程度中等;第三组:中年,男性,心血管危险因素患病率高,视网膜损伤程度高;第4组:年龄较小,男性,心血管危险因素患病率低,器官损害患病率低。在Kaplan Meier曲线中,第4类风险最低,而第3类风险最高(log rank p <;0.001)。在Cox回归中,所有聚类的死亡风险均高于聚类4;集群1 [HR 1.74(1.07-2.82)],集群2 [HR 1.87(1.20-2.91)],集群3 [HR 2.35(1.54-3.58)]。结论在我们的登记中发现了四个不同的表型簇,它们与死亡率有不同的关联。这些聚类为更有针对性的风险分层和预测提供了框架,对高危高血压人群的个体化患者护理具有指导意义。
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来源期刊
Current Problems in Cardiology
Current Problems in Cardiology 医学-心血管系统
CiteScore
4.80
自引率
2.40%
发文量
392
审稿时长
6 days
期刊介绍: Under the editorial leadership of noted cardiologist Dr. Hector O. Ventura, Current Problems in Cardiology provides focused, comprehensive coverage of important clinical topics in cardiology. Each monthly issues, addresses a selected clinical problem or condition, including pathophysiology, invasive and noninvasive diagnosis, drug therapy, surgical management, and rehabilitation; or explores the clinical applications of a diagnostic modality or a particular category of drugs. Critical commentary from the distinguished editorial board accompanies each monograph, providing readers with additional insights. An extensive bibliography in each issue saves hours of library research.
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