Sustained blood pressure control and progression of multimorbidity

项目摘要/摘要 多发病，定义为两种或两种以上慢性疾病的共同发生，是常见的且代价高昂的疾病，但 目前还没有推荐的治疗方法来延缓其进展。高血压(BP)既是 美国成年人中最常见的一种慢性病，也是许多其他慢性病的危险因素 条件。高血压的治疗有可能通过以下方式延缓多发病的进展 预防中风、冠心病(CHD)、心力衰竭(HF)、慢性肾病(CKD)、外周 血管疾病和心房颤动。尽管高血压治疗有效且价格低廉，但一大批 服用降压药的老年人血压不受控制的比例。年长的成年人描述 他们的健康目标是减轻慢性病负担，保持功能独立，以及 避免安置养老院，而不是实现针对疾病的治疗目标。因为之前 高血压临床试验将研究终点概念化为离散的结果，而不是收集 预示着功能衰退的结果，包括养老院安置，他们可能低估了好处 在人们经历慢性疾病共同发生的现实世界背景下，BP控制的重要性。这个 抗高血压和降脂治疗预防心脏病发作试验(ALLHAT)提供了一种独特的 具有成本效益的研究BP和多发病进展的机会。ALLHAT是一项大型的简单试验 1994年至1998年间42,418名高危高血压患者，旨在确定 三大类降压药的疗效比较。ALLHAT是研究多发病的理想药物 鉴于其广泛的纳入标准，以及大量的参与者&65岁的女性和非裔美国人。 我们将使用来自大约20,000名参与者的ALLHAT数据，包括65年的≥医疗保险服务费 承保并获得Medicare住院患者(A部分)、门诊患者(B部分)、PAC和长期护理索赔 解决以下具体目标：1)确定持续的BP控制对延迟的影响 多发病进展，2)评估持续的血压控制与发展之间的关系 对特定的高费用/高残疾慢性疾病组，3)比较降压效果 关于多发病进展和特定高成本/高残疾的发展的药物类别 慢性疾病组和4)确定延迟的多病进展对 住院患者和PAC在住院康复设施、熟练护理设施和家庭健康中的利用 养老院的服务和长期护理。目前的研究将提供证据来重新构建 从“治数”到更多以患者为中心的角度探讨血压控制。 最终，证明了在对老年人有影响的结果上维持受控BP的价值 包括减轻慢性病负担、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，以实现更好的血压控制。

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.