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Quantifying effects of blood pressure control on neuroimaging utilization in a large multi-institutional healthcare
Theodore R Welch1, Aliza Yaqub2, Danny Aiti3
1Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, United States of America.
Insights
Higher blood pressure is linked to increased neuroimaging use. Managing hypertension may reduce healthcare costs associated with CT and MR scans.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Health Services Research
Background:
- Essential hypertension is a prevalent condition impacting neurological health.
- Rising medical imaging costs necessitate understanding factors influencing neuroimaging utilization.
- The relationship between population blood pressure control and neuroimaging needs further investigation.
Purpose of the Study:
- To quantify the association between maximum annual blood pressure and same-year neuroimaging (CT/MR) utilization.
- To analyze this relationship within a large, multi-institutional healthcare population.
- To inform public health strategies for hypertension management and healthcare cost mitigation.
Main Methods:
- Retrospective, population-based cohort study using de-identified data from >140 health systems (2016, 2018, 2020).
- Included patients with recorded blood pressures ≥50 mmHg DBP or ≥90 mmHg SBP.
- Assessed neuroimaging CT and MR utilization based on maximum annual systolic and diastolic blood pressure thresholds.
Main Results:
- Analysis included over 38 million patients in the most recent year.
- Overall CT and MR utilization ranged from 3.8-5.1% and 1.5-2.0% respectively.
- Elevated blood pressure (≥140 mmHg systolic or ≥90 mmHg diastolic) correlated with 3-7 fold increases in same-year neuroimaging compared to <120/80 mmHg.
Conclusions:
- Higher annual maximum blood pressure is significantly associated with increased neuroimaging CT and MR utilization.
- Findings highlight the impact of hypertension on diagnostic imaging demand.
- Effective hypertension management is crucial for controlling healthcare expenditures related to neuroimaging.
Objectives:
Essential hypertension is a common chronic condition that can exacerbate or complicate various neurological diseases that may necessitate neuroimaging. Given growing medical imaging costs and the need to understand relationships between population blood pressure control and neuroimaging utilization, we seek to quantify the relationship between maximum blood pressure recorded in a given year and same-year utilization of neuroimaging CT or MR in a large healthcare population.
Methods:
A retrospective population-based cohort study was performed by extracting aggregate data from a multi-institutional dataset of patient encounters from 2016, 2018, and 2020 using an informatics platform (Cosmos) consisting of de-duplicated data from over 140 academic and non-academic health systems, comprising over 137 million unique patients. A population-based sample of all patients with recorded blood pressures of at least 50 mmHg DBP or 90 mmHg SBP were included. Cohorts were identified based on maximum annual SBP and DBP meeting or exceeding pre-defined thresholds. For each cohort, we assessed neuroimaging CT and MR utilization, defined as the percentage of patients undergoing ≥1 neuroimaging exam of interest in the same calendar year.
Results:
The multi-institutional population consisted of >38 million patients for the most recent calendar year analyzed, with overall utilization of 3.8-5.1% for CT and 1.5-2.0% for MR across the study period. Neuroimaging utilization increased substantially with increasing annual maximum BP. Even a modest BP increase to 140 mmHg systolic or 90 mmHg diastolic is associated with 3-4-fold increases in MR and 5-7-fold increases in CT same-year imaging compared to BP values below 120 mmHg / 80 mmHg.
Conclusion:
Higher annual maximum recorded blood pressure is associated with higher same-year neuroimaging CT and MR utilization rates. These observations are relevant to public health efforts on hypertension management to mitigate costs associated with growing imaging utilization.
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