老年人持续性血压控制与多种疾病进展的关联。
Association of Sustained Blood Pressure Control with Multimorbidity Progression Among Older Adults.
机构信息
Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.
Department of Medicine, Duke University, Durham, North Carolina, USA.
出版信息
J Am Geriatr Soc. 2020 Sep;68(9):2059-2066. doi: 10.1111/jgs.16558. Epub 2020 Jun 5.
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.
背景/目的：由于多种疾病相关的高成本和超额死亡率，需要开发延缓其进展的方法。高血压（BP）是一种常见的慢性疾病，也是许多其他慢性疾病的危险因素，使其成为干预的理想目标。本分析的目的是确定持续血压控制水平与多种疾病进展之间的关系。
设计
回顾性队列研究。
设置
抗高血压和降脂治疗预防心脏病试验（ALLHAT）与医疗保险索赔相关联。
参与者
共有 6591 名参加 ALLHAT 的 Medicare 参与者，他们在 8 次或更多次研究就诊时测量了收缩压（SBP）。
测量
SBP 控制分为 SBP 低于 140mmHg 的患者不到 50%、50%至<75%、75%至<100%和 100%就诊。多种疾病进展的定义是新出现的慢性疾病数量，包括关节炎、哮喘、心房颤动、癌症、慢性肾脏病、慢性阻塞性肺疾病、冠心病、痴呆、抑郁症、糖尿病、心力衰竭、高脂血症、骨质疏松症和中风。复发性事件生存分析用于计算持续 SBP 控制与多种疾病进展之间关联的比率比（RR）。
结果
每 10 人年（95%CI）的新发疾病率分别为 5.2（5.1-5.4）、4.7（4.5-4.8）、4.4（4.2-4.5）和 4.0（3.8-4.2），分别为 SBP 控制率低于 50%、50%至<75%、75%至<100%和 100%的参与者，中位随访时间为 9.0 年。与 SBP 控制率低于 50%就诊的参与者相比，SBP 控制率为 50%至<75%、75%至<100%和 100%就诊的参与者的调整 RR（95%CI）分别为 0.90（0.86-0.95）、0.85（0.81-0.89）和 0.77（0.72-0.82）。
结论
维持血压控制可能是减缓多种疾病进展的有效方法，并可能降低多种疾病的人群负担。
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