Sustained blood pressure control and progression of multimorbidity

持续血压控制和多种疾病的进展

• 批准号: 9472525
• 负责人: Christopher Barrett Bowling
• 金额: $ 43.58万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-15 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9472525
• 关键词: Sustained; blood; pressure; control; progression

Project Summary/Abstract Multimorbidity, defined as the co-occurrence of two or more chronic conditions, is common and costly, but currently there are no recommended treatments to delay its progression. High blood pressure (BP) is both the single most common chronic condition among US adults and a risk factor for many additional chronic conditions. Treatment of hypertension has the potential to delay the progression of multimorbidity by preventing stroke, coronary heart disease (CHD), heart failure (HF), chronic kidney disease (CKD), peripheral vascular disease, and atrial fibrillation. Although hypertension treatments are effective and inexpensive, a large percentage of older adults taking antihypertensive medications have uncontrolled BP. Older adults describe their health goals in terms of reducing the burden of chronic disease, maintaining functional independence, and avoiding nursing home placement, in contrast to achieving disease-specific treatment goals. Because prior hypertension clinical trials have conceptualized study endpoints as discrete outcomes and not collected outcomes that signal functional decline including nursing home placement, they may underestimate the benefit of BP control in the real-world context where people experience co-occurring chronic conditions. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) provides a unique and cost efficient opportunity to study BP and the progression of multimorbidity. ALLHAT is a large simple trial of 42,418 high-risk hypertensive patients between 1994 and 1998 and was designed to determine the differential effect of antihypertensive medications from three drug classes. ALLHAT is ideal for studying multimorbidity given its broad inclusion criteria, and large number of participants > 65 years, women, and African Americans. We will use ALLHAT data from approximately 20,000 participants ≥ 65 years with Medicare fee-for-service coverage and obtain Medicare inpatient (Part A), outpatient (Part B), PAC, and long-term care claims to address the following specific aims: 1) to determine the impact of sustained BP control on the delay of multimorbidity progression, 2) to evaluate the associations between sustained BP control and the development of specific high cost/high disability chronic condition clusters, 3) to compare the effect of antihypertensive medication classes on multimorbidity progression and the development of specific high cost/high disability chronic condition clusters and 4) to determine the long-term impact of delayed multimorbidity progression on inpatient and PAC utilization in inpatient rehabilitation facilities, skilled nursing facilities, and home health services and long-term care in nursing homes. The current study will provide evidence to reframe the discussion about BP control from a “treating the numbers” perspective to more patient-centered perspective. Ultimately, demonstrating the value of sustaining controlled BP on outcomes that matter to older adults including reducing the burden of chronic disease, maintaining functional independence, and avoiding nursing home placement, will provide motivation to both physicians and patients to work to achieve better BP control.

项目总结/摘要 多发病，定义为两种或多种慢性疾病的共同发生，是常见的和昂贵的，但 目前没有推荐的治疗方法来延缓其进展。高血压（BP）是指 美国成年人中最常见的一种慢性疾病，也是许多其他慢性疾病的风险因素 条件高血压的治疗有可能通过以下方式延缓多原发性高血压的进展： 预防中风、冠心病（CHD）、心力衰竭（HF）、慢性肾病（CKD）、外周血 血管疾病和心房纤颤。虽然高血压治疗是有效的和廉价的， 服用抗高血压药物的老年人血压不受控制的百分比。老年人描述 他们的健康目标是减少慢性病的负担，保持功能独立性， 避免养老院安置，与实现疾病特异性治疗目标相反。因为现有 高血压临床试验将研究终点概念化为离散结局，未收集 结果，信号功能下降，包括养老院安置，他们可能低估了好处 BP控制在现实世界的背景下，人们经历共同发生的慢性疾病。的 抗高血压和降脂治疗，以防止心脏病发作试验（ALLHAT）提供了一个独特的， 成本效益的机会，研究BP和多发病的进展。ALLHAT是一个大型的简单试验， 1994年至1998年，42，418例高危高血压患者，旨在确定 三种药物类别的抗高血压药物的作用。ALLHAT是研究多形态的理想工具 鉴于其广泛的纳入标准，以及大量参与者> 65岁，女性和非裔美国人。 我们将使用来自约20，000名年龄≥ 65岁的Medicare付费服务参与者的ALLHAT数据 覆盖范围，并获得医疗保险住院（A部分），门诊（部分B），PAC和长期护理索赔， 解决以下具体目标：1）确定持续BP控制对延迟的影响， 2）评估持续血压控制与发展之间的相关性， 具体的高成本/高残疾慢性疾病集群，3）比较降压的效果 关于多发性硬化症进展和特定高成本/高残疾发展的药物类别 慢性疾病集群和4）以确定延迟的多发性硬化症进展对 住院康复机构、熟练护理机构和家庭健康中的住院和PAC利用率 护理和长期护理在养老院。目前的研究将提供证据来重新构建 从“处理数字”的角度讨论血压控制，以更多的病人为中心的角度。 最终，证明维持控制血压对老年人重要的结果的价值 包括减轻慢性病的负担，保持功能独立，避免护理 家庭安置将为医生和患者提供动力，努力实现更好的血压控制。