Association of Sustained Blood Pressure Control with Lower Risk for High-Cost Multimorbidities Among Medicare Beneficiaries in ALLHAT
- 9 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of General Internal Medicine
- Vol. 36 (8), 2221-2229
- https://doi.org/10.1007/s11606-021-06623-w
Abstract
Background Clustering of chronic conditions is associated with high healthcare costs. Sustaining blood pressure (BP) control could be a strategy to prevent high-cost multimorbidity clusters. Objective To determine the association between sustained systolic BP (SBP) control and incident multimorbidity cluster dyads and triads. Design Cohort study of Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) linked to Medicare claims. Participants ALLHAT included adults with hypertension and ≥1 coronary heart disease risk factor. This analysis was restricted to 5234 participants with ≥ 8 SBP measurements during a 48-month BP assessment period. Main Measures SBP control was defined as <140 mm Hg at <50%, 50 to <75%, 75 to <100%, and 100% of study visits during the BP assessment period. High-cost multimorbidity clusters included dyads (stroke/chronic kidney disease [CKD], stroke/chronic obstructive pulmonary disease [COPD], stroke/heart failure [HF], stroke/asthma, COPD/CKD) and triads (stroke/CKD/asthma, stroke/CKD/COPD, stroke/CKD/depression, stroke/CKD/HF, stroke/HF/asthma) identified during follow-up. Key Results Incident dyads occurred in 1334 (26%) participants and triads occurred in 481 (9%) participants over a median follow-up of 9.2 years. Among participants with SBP control at <50%, 50 to <75%, 75 to <100%, and 100% of visits, 32%, 23%, 23%, and 19% of participants developed high-cost dyads, respectively, and 13%, 9%, 8%, and 5% of participants developed high-cost triads, respectively. Compared to those with sustained BP control at <50% of visits, adjusted HRs (95% CI) for incident dyads were 0.66 (0.57, 0.75), 0.67 (0.59, 0.77), and 0.51 (0.42, 0.62) for SBP control at 50 to <75%, 75 to <100%, and 100% of visits, respectively. The corresponding HRs (95% CI) for incident triads were 0.69 (0.55, 0.85), 0.56 (0.44, 0.71), and 0.32 (0.22, 0.47). Conclusions Among Medicare beneficiaries in ALLHAT, sustained SBP was associated with a lower risk of developing high-cost multimorbidity dyads and triads.Keywords
Funding Information
- National Heart, Lung, and Blood Institute (R01HL133618)
- National Institute on Aging (R01AG062502)
This publication has 31 references indexed in Scilit:
- Effects of Blood Pressure Reduction in Mild HypertensionAnnals of Internal Medicine, 2015
- Defining and Measuring Chronic Conditions: Imperatives for Research, Policy, Program, and PracticePreventing Chronic Disease, 2013
- Multimorbidity in Older AdultsEpidemiologic Reviews, 2013
- Impact of Chronic Kidney Disease on Activities of Daily Living in Community-Dwelling Older AdultsThe Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 2011
- The Triple Aim: Care, Health, And CostHealth Affairs, 2008
- Treatment of Hypertension in Patients 80 Years of Age or OlderThe New England Journal of Medicine, 2008
- Choice of time‐scale in Cox's model analysis of epidemiologic cohort data: a simulation studyStatistics in Medicine, 2004
- Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)JAMA, 2002
- Predominance of Isolated Systolic Hypertension Among Middle-Aged and Elderly US HypertensivesHypertension, 2001
- Time-to-Event Analysis of Longitudinal Follow-up of a Survey: Choice of the Time-scaleAmerican Journal of Epidemiology, 1997