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Sustained SBP control and long-term nursing home admission among Medicare beneficiaries
C Barrett Bowling1,2, Richard Sloane3, Carl Pieper3
1Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC).
Insights
Maintaining controlled blood pressure significantly lowers the risk of nursing home admission. Consistent systolic blood pressure (SBP) control in older adults is linked to reduced long-term care needs.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Public Health
Background:
- Sustained systolic blood pressure (SBP) control is known to reduce cardiovascular events.
- However, the association between consistent SBP control and nursing home admission remains understudied.
Purpose of the Study:
- To investigate the relationship between sustained systolic blood pressure (SBP) control and the risk of long-term nursing home admission.
- To analyze data from a large clinical trial and linked Medicare claims to assess this association.
Main Methods:
- Analysis of data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) linked to Medicare claims.
- Inclusion criteria: fee-for-service Medicare, at least eight study visits with SBP measurements, and no nursing home residency at baseline.
- Sustained SBP control was categorized based on the percentage of visits with SBP < 140 mmHg; nursing home admissions were identified via Medicare claims.
Main Results:
- The study included 6557 participants with a median follow-up of 9.2 years.
- A total of 844 participants (12.8%) were admitted to a nursing home.
- Higher percentages of sustained SBP control were associated with significantly lower rates and risks of nursing home admission, with hazard ratios ranging from 0.57 to 0.79 compared to <50% control.
Conclusions:
- Sustained systolic blood pressure (SBP) control is associated with a reduced risk of long-term nursing home admission among Medicare beneficiaries in the ALLHAT study.
- Effective blood pressure management may play a role in maintaining functional independence and reducing the need for long-term care.
Objectives:
Sustaining SBP control reduces the risk for cardiovascular events that impair function but its association with nursing home admission has not been well studied.
Methods:
We conducted an analysis of sustained SBP control and long-term nursing home admissions using data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) linked to Medicare claims restricted to participants with fee-for-service coverage, at least eight study visits with SBP measurements, who were not living in a nursing home during a 48-month baseline BP assessment period (n = 6557). Sustained SBP control was defined as less than 140 mmHg at less than 50%, 50% to less than 75%, 75% to less than 100%, and 100% of visits. Nursing home admissions were identified using the Medicare Long Term Care Minimum Data Set.
Results:
The mean age of participants was 73.8 years and 44.3% were men. Over a median follow-up of 9.2 years, 844 participants (12.8%) had a nursing home admission. Rates of nursing home admission per 100 person-years were 16.3 for participants with SBP control at less than 50%, 14.1 at 50% to less than 75%, 7.8 at 75% to less than 100%, and 5.3 at 100% of visits. Compared with those with sustained SBP control at less than 50% of visits, hazard ratios (95% confidence intervals) for nursing home admission were 0.79 (0.66-0.93), 0.70 (0.58-0.84), and 0.57 (0.44-0.74) among participants with SBP control at 50% to less than 75%, 75% to less than 100%, and 100% of visits, respectively.
Conclusion:
Among Medicare beneficiaries in ALLHAT, sustained SBP control was associated with a lower risk of long-term nursing home admission.
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