C Barrett Bowling1,2, Richard Sloane3, Carl Pieper3, Alison Luciano3, Barry R Davis4, Lara M Simpson4, Paula T Einhorn5, Suzanne Oparil6, Paul Muntner7. 1. Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA. 2. Department of Medicine, Duke University, Durham, North Carolina, USA. 3. Center for Study of Aging and Human Development, Duke University, Durham, North Carolina, USA. 4. The University of Texas School of Public Health, Houston, Texas, USA. 5. Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland, USA. 6. Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. 7. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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.
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.
Authors: C Barrett Bowling; Laura Plantinga; Lawrence S Phillips; William McClellan; Katharina Echt; Neale Chumbler; Gerald McGwin; Ann Vandenberg; Richard M Allman; Theodore M Johnson Journal: J Am Geriatr Soc Date: 2016-11-23 Impact factor: 5.562
Authors: C Barrett Bowling; Ann E Vandenberg; Lawrence S Phillips; William M McClellan; Theodore M Johnson; Katharina V Echt Journal: Clin J Am Soc Nephrol Date: 2017-04-03 Impact factor: 8.237
Authors: Jeff D Williamson; Mark A Supiano; William B Applegate; Dan R Berlowitz; Ruth C Campbell; Glenn M Chertow; Larry J Fine; William E Haley; Amret T Hawfield; Joachim H Ix; Dalane W Kitzman; John B Kostis; Marie A Krousel-Wood; Lenore J Launer; Suzanne Oparil; Carlos J Rodriguez; Christianne L Roumie; Ronald I Shorr; Kaycee M Sink; Virginia G Wadley; Paul K Whelton; Jeffrey Whittle; Nancy F Woolard; Jackson T Wright; Nicholas M Pajewski Journal: JAMA Date: 2016-06-28 Impact factor: 56.272
Authors: Karen Barnett; Stewart W Mercer; Michael Norbury; Graham Watt; Sally Wyke; Bruce Guthrie Journal: Lancet Date: 2012-05-10 Impact factor: 79.321
Authors: C Barrett Bowling; Richard Sloane; Carl Pieper; Alison Luciano; Barry R Davis; Lara M Simpson; Paula T Einhorn; Suzanne Oparil; Paul Muntner Journal: J Hypertens Date: 2021-11-01 Impact factor: 4.776
Authors: C Barrett Bowling; Richard Sloane; Carl Pieper; Alison Luciano; Barry R Davis; Lara M Simpson; Paula T Einhorn; Suzanne Oparil; Paul Muntner Journal: J Gen Intern Med Date: 2021-02-09 Impact factor: 6.473