Joint Trajectories of Blood Pressure and Heart Rate and Their Association with Relative Change in Relative Wall Thickness in Hypertensive Patients: A Group-Based Multi-Trajectory Modeling Analysis (Preprint)
Bibliographic record
Abstract
Abstract Background Ambulatory blood pressure monitoring objectively assesses circadian hemodynamic rhythms. However, the joint trajectories of longitudinal blood pressure (BP) and heart rate (HR), and their association with early hypertensive cardiac remodeling, remain incompletely characterized. Objective This study aimed to identify joint trajectories of BP and HR using group-based multitrajectory modeling and examine their associations with relative changes in relative wall thickness ( Δ RWT). Methods This community-based longitudinal cohort study included 213 patients with hypertension, with data collected between November 2022 and January 2025. Participants underwent 4 ambulatory BP monitoring sessions over 6 months, and echocardiography was measured at 3 months and 9 months. Group-based multitrajectory modeling was used to identify joint trajectories of 24-hour mean systolic blood pressure, diastolic blood pressure, and HR. A full-model multiple linear regression estimated the associations between trajectory groups and Δ RWT. Sensitivity analyses were conducted by adjusting for age and sex, and by using complete-case data. Results Four joint trajectory groups were identified: group 1 (lowest BP and HR, n=59), group 2 (normal BP, high HR, n=60), group 3 (stage 1 hypertension range, normal HR, n=54), and group 4 (stage 2 hypertension range, high HR, n=40). In the primary adjusted multiple linear regression model, compared with group 4, group 2 showed a significant inverse association with changes in Δ RWT ( b =−0.059, 95% CI −0.112 to −0.007; P =.03). Antidiabetic medication use was significantly associated with a reduction in Δ RWT ( b =−0.067, 95% CI −0.116 to −0.018; P =.008). Waking up before 7 AM was positively associated with an increase in Δ RWT ( b =0.045, 95% CI 0.007-0.083; P =.02). Notably, the association for group 2 attenuated to marginal significance ( P =.06) in the complete-case analysis, primarily due to the reduction in statistical power. Conclusions Hypertensive cardiac remodeling exhibits significant heterogeneity across distinct joint systolic blood pressure, diastolic blood pressure, and HR trajectories. Stable BP control is associated with a potential attenuation of early cardiac remodeling even in the presence of an elevated HR; however, this beneficial association attenuated to marginal significance in the complete-case analysis. Concurrent antidiabetic medication use and waking after 7 AM showed a beneficial association with the relative change in Δ RWT.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".