Group-Based Multitrajectory Modeling Analysis of Joint Trajectories of Blood Pressure and Heart Rate and Their Association With Relative Change in Relative Wall Thickness in Patients With Hypertension: Community-Based Longitudinal Cohort Study

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.