Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug;36(8):2221-2229.
doi: 10.1007/s11606-021-06623-w. Epub 2021 Feb 9.

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

C Barrett Bowling  1   2 , Richard Sloane  3 , Carl Pieper  3 , Alison Luciano  3 , Barry R Davis  4 , Lara M Simpson  4 , Paula T Einhorn  5 , Suzanne Oparil  6 , Paul Muntner  7
Affiliations

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

C Barrett Bowling et al. J Gen Intern Med. 2021 Aug.

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: aging; blood pressure control; hypertension; multimorbidity; systolic blood pressure.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Study design. Data from participants of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) were linked to Medicare health insurance claims. ALLHAT data were used to determine sustained blood pressure (BP) control during the BP assessment period. Follow-up in Medicare claims began on the date corresponding to the end of the BP assessment period for each participant. The follow-up period was used to identify incident multimorbidity dyads and triads.
Figure 2
Figure 2
Cumulative incidence of multimorbidity cluster dyads (a) and triads (b) relative to the start of Medicare follow-up.
Figure 3
Figure 3
Multivariable adjusted hazard ratios (95% CI) for the development of high-cost multimorbidity dyads and triads by percentage of visits with systolic blood pressure control. Multivariable adjustment includes sex, race, education, history of diabetes and hyperlipidemia, and smoking status at time of ALLHAT randomization. N=5234. Additional models are displayed in Supplemental Table 1.
Figure 4
Figure 4
Percentage of ALLHAT participants who developed each of the five high-cost multimorbidity cluster dyads (a) and triads (b) by level of sustained systolic blood pressure control during Medicare follow-up. CKD chronic kidney disease, COPD chronic obstructive pulmonary disease, HF heart failure. N=5234.
See this image and copyright information in PMC

References

    1. Salive ME. Multimorbidity in older adults. Epidemiol Rev. 2013;35:75–83. doi: 10.1093/epirev/mxs009. - DOI - PubMed
    1. Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002;162(20):2269–2276. doi: 10.1001/archinte.162.20.2269. - DOI - PubMed
    1. Bowling CB, Plantinga L, Phillips LS, et al. Association of Multimorbidity with Mortality and Healthcare Utilization in Chronic Kidney Disease. J Am Geriatr Soc. 2017;65(4):704–711. doi: 10.1111/jgs.14662. - DOI - PubMed
    1. Hall RK, Zhou H, Reynolds K, Harrison TN, Bowling CBA. Novel Approach to Developing a Discordance Index for Older Adults With Chronic Kidney Disease. J Gerontol A Biol Sci Med Sci. 2020;75(3):522–528. doi: 10.1093/gerona/glz248. - DOI - PMC - PubMed
    1. Centers for Medicare and Medicaid Services. Chronic Conditions among Medicare Beneficiaries, Chartbook, 2012 Edition. Baltimore, MD. 2012.

Publication types

Substances