Quantifying Compliance to the New 2017 Hypertension Treatment Guidelines and Investigating the Association Between Guideline Compliance and Patients' Trajectory of Blood Pressure

项目摘要/摘要 血压为140/90毫米汞柱会使心血管疾病(CVD)的风险增加一倍，并使 高血压每年高达510亿美元。尽管存在巨大的风险和成本，但 高血压，不到一半(48.3%)的高血压患者的血压(BP)在 美国。临床试验表明，使用该药可实现高达85%的血压控制率。 目前可用的治疗方法，并严格遵循推荐的治疗方案。这表明一个 更高比例的失控BP可以解释为较少的积极治疗，较差的随访，以及 使用更少或更不有效的药物。2017年BP高层管理指南最近发布， 将开始用药的门槛和无控制血压的定义降低到BP≥130/80 mm Hg (从140/90)用于心血管疾病或更高风险的患者。这对医生们提出了挑战，要改变他们的 传统的高血压治疗，可能会使本已很低的遵从率(25%-65%)恶化到 高血压治疗指南。此外，从以前的研究得出的关于遵守 由于未能评估高血压治疗的多个方面，较旧的高血压治疗指南受到了损害 高血压护理，如合并症、随访和实验室评估；以及主观使用 医生自我报告等评估。电子健康档案(EHR)的广泛采用 技术和电子病历数据中的重要患者信息提供了一个绝佳的机会 客观评估高血压治疗的几个方面，如开出的药物、实验室 订购的程序、达到的血压水平、后续监测检查、人口统计和合并疾病 信息。因此，我们建议使用西北医药企业数据仓库(NMEDW) -一个包含290万患者健康信息的综合电子健康记录数据库，用于1)评估遵守 2017高血压管理指南发布5年(2018-2022年)；2)调查是否 患者的年龄、种族、体重指数、糖尿病病史、心血管疾病、慢性肾脏疾病、服药依从性、 医疗保险和正规医生的存在，以及医生的专业预测遵守程度 新的治疗指南；以及3)检查2017年的遵从性水平与 高血压治疗指南和未来5年(2019-2023年)患者的血压轨迹。新开 确诊高血压患者的人口学、血压、药物、实验室结果、随访和合并症 将从NMEDW对条件进行评估，并将其与基于2017年 高血压治疗指南，以量化指南的遵从性。拟议的研究提供了 应聘者有机会学习电子病历数据挖掘技能，以评估新的合规性与 高血压治疗指南和患者血压轨迹，并确定这种依从性的预测因素，作为第一次 在设计未来有针对性的干预措施以加强指南遵从性和BP控制方面。

Project Summary/Abstract Blood pressure (BP) of ³140/90 mm Hg doubles the risk of cardiovascular diseases (CVD) and the total cost of hypertension reaches as high as $51 billion per year. Despite the enormous risk and cost associated with hypertension, less than half (48.3%) of hypertensive patients have a controlled blood pressure (BP) in the United States. Clinical trials demonstrated that a high rate of BP control (up to 85%) can be achieved with currently available therapies and strictly following recommended treatment protocols. This suggests that a higher proportion of uncontrolled BP could be explained by less aggressive treatment, poorer follow-up, and use of fewer or less effective drugs. The 2017 guideline for high BP management was recently published and lowered the threshold for the initiation of medication and definition of uncontrolled BP to BP ≥130/80 mm Hg (from 140/90) for patients with CVD or higher risk of CVD. This challenges physicians to change their traditional hypertension management and could worsen the already low rate of compliance (range 25-65%) to hypertension treatment guidelines. Furthermore, conclusions from previous studies regarding compliance to older hypertension treatment guidelines were compromised due to failure to evaluate multiple aspects of hypertension care, such as comorbidities, follow-up and laboratory assessments; and use of subjective assessment such as physician self-report. The wide-spread adoption of electronic health record (EHR) technology and the vital patient information present in EHR data provide an exceptional opportunity to objectively evaluate several aspects of hypertension care, such as medications prescribed, laboratory procedures ordered, BP level achieved, follow-up monitoring examinations, demographic and comorbid information. We, therefore, propose to use the Northwestern Medicine Enterprise Data Warehouse (NMEDW) – an integrated EHR database of health information from 2.9 million patients to 1) assess compliance to the 2017 hypertension management guidelines for 5 years since its release (2018-2022); 2) investigate whether patient’s age, race, body mass index, history of diabetes, CVD, chronic kidney disease, medication adherence, presence of health insurance and regular physician, and physican speciality predict level of compliance to the new treatment guideline; and 3) examine the association between level of compliance to the 2017 hypertension treatment guidelines and prospective patient BP trajectory over 5 years (2019-2023). Newly diagnosed hypertensive patients’ demographics, BP, medications, lab results, follow-up visit, and comorbid conditions will be assessed from the NMEDW and will be compared to criteria developed based on the 2017 hypertension treatment guidelines to quantify compliance to the guideline. The proposed study provides the candidate an opportunity to learn EHR data-mining skills to assess association between compliance to the new hypertension treatment guideline and patient BP trajectory and to identify predictors of this compliance, as a first step, in designing future targeted interventions to enhance guideline compliance and BP control.