Association of Sustained Blood Pressure Control with Multimorbidity Progression Among Older Adults

Abstract

BACKGROUND/OBJECTIVES Due to the high costs and excess mortality associated with multimorbidity, there is a need to develop approaches for delaying its progression. High blood pressure (BP) is a common chronic condition and a risk factor for many additional chronic conditions, making it an ideal target for intervention. The purpose of this analysis was to determine the association between the level of sustained BP control and the progression of multimorbidity. DESIGN Retrospective cohort study. SETTING Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) linked to Medicare claims. PARTICIPANTS A total of 6,591 ALLHAT participants with Medicare who had systolic BP (SBP) measurements at eight or more study visits. MEASUREMENTS SBP control was categorized as lower than 140 mm Hg at less than 50%, 50% to less than 75%, 75% to less than 100%, and 100% of visits. Multimorbidity progression was defined by the number of incident chronic conditions, including arthritis, asthma, atrial fibrillation, cancer, chronic kidney disease, chronic obstructive pulmonary disease, coronary heart disease, dementia, depression, diabetes mellitus, heart failure, hyperlipidemia, osteoporosis, and stroke. Recurrent event survival analysis was used to calculate rate ratios (RRs) for the association of sustained SBP control with progression of multimorbidity. RESULTS Rates of incident conditions per 10 person‐years (95% CIs) were 5.2 (5.1–5.4), 4.7 (4.5–4.8), 4.4 (4.2–4.5), and 4.0 (3.8–4.2) for participants with SBP control at less than 50%, 50% to less than 75%, 75% to less than 100%, and 100% of visits, respectively, over a median follow‐up of 9.0 years. Compared with participants with SBP control at less than 50% of visits, adjusted RRs (95% CIs) for multimorbidity progression were 0.90 (0.86–0.95), 0.85 (0.81–0.89), and 0.77 (0.72–0.82) for those with SBP control at 50% to less than 75%, 75% to less than 100%, and 100% of visits, respectively. CONCLUSIONS Sustaining BP control may be an effective approach to slow multimorbidity progression and may reduce the population burden of multimorbidity.

Sustained SBP control and long-term nursing home admission among Medicare beneficiaries

“…For example, Mancia et al [26,27] reported lower risk for CVD events including MI, heart failure, and stroke associated with BP control at a greater percentage of visits in two separate analyses, from the INVEST (International Verapamil SR-Trandolapril) trial, which enrolled participants with hypertension in addition to coronary artery disease and the VALUE (Valsartan Antihypertensive Long-term use Evaluation) trial, which included those with hypertension and three or more CVD risk factors. A previous analysis using data from the ALLHAT-CMS linkage identified an inverse association between sustained SBP control and progression of multimorbidity defined as the rate of accumulation of chronic conditions over time [9,10]. In that analysis, sustained SBP control at 100% of visits versus less than 50% of visits corresponded to estimated delays in the development of six or more chronic conditions from 68 to 76 years of age.…”

Evidence-based perspective on heart failure and osteoporosis: a systematic review

“…В японском исследовании было продемонстрировано увеличение потребности в долгосрочном уходе у пациентов с систолической дисфункцией левого желудочка (ЛЖ) и ОП (ОШ 1,74; 95% ДИ 1,25-2,41) [19]. Строгий конт роль артериального давления оказался важен для снижения прогрессирования ухудшения состояния здоровья мультиморбидных пациентов с ХСН и ОП [16].…”

Association of Sustained Blood Pressure Control with Lower Risk for High-Cost Multimorbidities Among Medicare Beneficiaries in ALLHAT

“…1). 11 ALLHAT enrolled men and women aged 55 years or older who had hypertension and at least one additional coronary heart disease (CHD) risk factor between 1994 and 1998. 12,13 CHD risk factors in ALLHAT included history of a myocardial infarction, stroke, left ventricular hypertrophy, history of type 2 diabetes mellitus, current cigarette smoking, high-density lipoprotein (HDL) < 35 mg/dL, or documentation of other atherosclerotic CVD.…”

“…Therefore, sustained SBP control could be clearly communicated with patients and may provide a meaningful metric for reporting improvement over time. 11,18…”

“…Sustaining BP control at a greater percentage of visits over time has been shown to be associated with a slower progression of multimorbidity, delaying the age of onset of six or more chronic conditions by 8 years. 11 The percentage of visits at which patients achieve BP control can easily be calculated, could be used to guide discussions with patients about treatment goals, and could be used as a performance measure for quality improvement. The purpose of the current analysis was to determine the association between the percentage of visits with sustained BP control and incident high-cost multimorbidity cluster dyads and triads in an observational analysis of a large hypertension clinical trial.…”