ALLHAT 研究中，持续性血压控制与医疗保险受益人群发生高费用多病共存的风险降低相关。

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

机构信息

Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, NC, USA.

Department of Medicine, Duke University, Durham, NC, USA.

出版信息

J Gen Intern Med. 2021 Aug;36(8):2221-2229. doi: 10.1007/s11606-021-06623-w. Epub 2021 Feb 9.

DOI:10.1007/s11606-021-06623-w

PMID:33564944

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8342657/

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.

摘要

背景

慢性疾病的聚类与高额医疗费用有关。维持血压（BP）控制可能是预防高成本多病种聚类的一种策略。

目的

确定持续收缩压（SBP）控制与新发多病种聚类对和聚类三对之间的关联。

设计

抗高血压和降脂治疗预防心脏病试验（ALLHAT）的队列研究与医疗保险索赔相关联。

参与者

ALLHAT 纳入了患有高血压和≥1 个冠心病危险因素的成年人。本分析仅限于在 48 个月的 BP 评估期间进行了≥8 次 SBP 测量的 5234 名参与者。

主要测量

SBP 控制定义为在 BP 评估期间的<50%、50-<75%、75-<100%和 100%就诊时的<140mmHg。高成本多病种聚类包括在随访期间出现的对（中风/慢性肾脏病[CKD]、中风/慢性阻塞性肺疾病[COPD]、中风/心力衰竭[HF]、中风/哮喘）和三对（中风/CKD/哮喘、中风/CKD/COPD、中风/CKD/抑郁、中风/CKD/HF、中风/HF/哮喘）。

主要结果

在中位随访 9.2 年后，1334 名（26%）参与者出现了新发对，481 名（9%）参与者出现了聚类三对。在 SBP 控制<50%、50-<75%、75-<100%和 100%就诊的参与者中，分别有 32%、23%、23%和 19%的参与者发生了高成本对，分别有 13%、9%、8%和 5%的参与者发生了高成本聚类三对。与持续 SBP 控制<50%就诊的参与者相比，SBP 控制在 50-<75%、75-<100%和 100%就诊的参与者发生新发对的调整 HR（95%CI）分别为 0.66（0.57，0.75）、0.67（0.59，0.77）和 0.51（0.42，0.62），发生新发聚类三对的调整 HR（95%CI）分别为 0.69（0.55，0.85）、0.56（0.44，0.71）和 0.32（0.22，0.47）。