"Later, lazier, and unluckier”: a heuristic profile of high vulnerability is an independent predictor of uncontrolled blood pressure (the PREVIEW study)

Ivo Abraham^1,2, Christopher Lee^1,2, MinKyoung Song^1,3, Stefaan Vancayzeele⁴, Heidi Brié⁴, Christine Hermans⁴, Patricia Van der Niepen⁵, Karen MacDonald²

¹University of Arizona, Tucson, AZ, USA; ²Matrix45, Earlysville, VA, USA; ³School of Nursing, University of Pennsylvania, Philadelphia, PA, USA; ⁴Department of Nephrology and Hypertension, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium; ⁵Novartis Pharma, Vilvoorde, Belgium

Objective: Vulnerability profiling, an alternative to deterministic risk assessment, offers clinicians a more intuitive but empirically-grounded assessment of patient risk. This study aimed to determine whether a heuristic profile of high vulnerability is an independent predictor of uncontrolled hypertension.

Methods: Secondary analysis of prospective observational study data on 2999 hypertensive patients treated with valsartan. Predictive validity of vulnerability profiling for first-line, secondline, and first-or-second-line antihypertensive treatment was inferred from 1) logistic regression models with adequate statistical fit, 2) statistically significant odds ratios for uncontrolled BP for the high-vulnerability cluster exceeding 1.00, and 3) correct classification rates for patients’ BP control status.

Results: All models of uncontrolled BP were significant (P < 0.001); all odds ratios for the high-vulnerability cluster were greater than 1.00 and significant (P < 0.001). Correct classification rates for the highly-vulnerability cluster on uncontrolled BP after first-line, second-line, or either treatment were 91.1%, 61.2%, and 93.5% for systolic BP; 74.5%, 65.8%, and 76.7% for diastolic BP; and 92.8%, 65.3%, and 94.6% for combined systolic and diastolic BP.

Conclusion: The heuristic profile of “later, lazier, and unluckier” is an intuitive and valid tool to help identify patients at greater risk for poor BP control seen in general practice.

Keywords: hypertension, heuristics, vulnerability, profiling, risk