Mortality and Macrovascular Risk in Elderly With Hypertension and Diabetes: Effect of Intensive Drug Therapy.

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Yashkin, AP; Kravchenko, J; Yashin, AI; Sloan, F

Published Date

  • January 2018

Published In

Volume / Issue

  • 31 / 2

Start / End Page

  • 220 - 227

PubMed ID

  • 28985276

Pubmed Central ID

  • 28985276

Electronic International Standard Serial Number (EISSN)

  • 1941-7225

International Standard Serial Number (ISSN)

  • 0895-7061

Digital Object Identifier (DOI)

  • 10.1093/ajh/hpx151

Language

  • eng