Future hypertension guidelines for older americans with multiple chronic conditions

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Background

Disease management guidelines focus primarily on a single disease and comment on relationships to other single diseases, while many patients have multiple chronic conditions. The 2001 Institute of Medicine’s landmark report, Crossing the Quality Chasm, noted limitations of disease management guidelines for single chronic conditions as a majority of healthcare dollars are spent on patients with multiple chronic conditions (MCC), which increase with age.

Methods

Modified Elixhauser and Charlson conditions were used to classify 50,000 Shared Savings Program (Medicare) beneficiaries in a clinically integrated healthcare system in SC. An agglomerative hierarchical clustering approach was used to classify this patient group into 12 clusters.

Results

72% of MSSP beneficiaries had a hypertension (HTN) diagnosis. Five clusters, 27% of patients, had only a small proportion with MCC. These groups included ‘healthy’, isolated hyperlipidemia (HLP), uncomplicated HTN, osteoarthritis, and obesity. The remaining 73% of MSSP beneficiaries had MCC, which clustered into 7 dominant themes, e.g., diabetes (13%), CHF (12%), cancer (11%), vascular disease (11%), COPD (10%), CKD (9%) and behavioral health (7%). For example, in the CHF cluster, 91% of

Conclusions

HTN in older Americans typically occurs in combination with MCC including behavioral disorders. Most clinical trials have not included a representative sample of older hypertensive patients. The appropriate BP goal for many of these patients is, therefore, uncertain. There is a critical need for (i) clinical guidelines that address the complexity of older patients with hypertension and MCC encountered daily by primary care clinicians (ii) large-scale, practical clinical trials conducted in

Keywords

hypertension; guideline; elderly

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