Mortality and Macrovascular Risk in Elderly With Hypertension and Diabetes: Effect of Intensive Drug Therapy.
BACKGROUND
This study identifies the effect of intensive drug therapy (IDT) in individuals age 65+ with diabetes (type 2 diabetes mellitus (T2D)) and hypertension on all-cause death, congestive heart failure (CHF), hospitalization for myocardial infarction (MI), and stroke or transient ischemic attack (TIA).


METHODS
Individuals from the Medicare 5% dataset with hypertension and T2D undergoing IDT for these conditions were propensity score matched to a nonintensive drug-therapy group. Hazard ratios (HRs) were obtained using the Cox proportional hazard model.


RESULTS
IDT was associated with increased risk of CHF (HR 2.32; 95% confidence interval (CI) 2.32-2.38), MI (HR 4.27; 95% CI 4.05-4.52), and stroke or TIA (HR 1.80; 95% CI 1.70-1.89) but decreased risk of death (HR 0.95; 95% CI 0.93-0.97). Risk for CHF (HR 0.73; 95% CI 0.71-0.73), MI (HR 0.64; 95% CI 0.62-0.67), stroke or TIA (HR 0.82; 95% CI 0.78-0.86), and death (HR 0.29; 95% CI 0.28-0.29) was decreased by adherence to diabetes management guidelines.


CONCLUSIONS
Use of IDT in a high-risk population delays death but not severe macrovascular outcomes. Protective effects of IDT in high-risk patients likely outweigh polypharmacy-related health concerns.
['Yashkin|Arseniy P|AP|', 'Kravchenko|Julia|J|', 'Yashin|Anatoliy I|AI|', 'Sloan|Frank|F|']
D000368:Aged D000959:Antihypertensive Agents D002423:Cause of Death D003924:Diabetes Mellitus, Type 2 D005260:Female D006333:Heart Failure D006760:Hospitalization D006801:Humans D006973:Hypertension D007004:Hypoglycemic Agents D008297:Male D006278:Medicare D055118:Medication Adherence D009026:Mortality D009203:Myocardial Infarction D018570:Risk Assessment D012307:Risk Factors D020521:Stroke D014481:United States
mortality hypertension intensive drug therapy diabetes mellitus adherence macrovascular outcomes blood pressure