Abstract P333: What is the Association between Severe Mental Illness and Hypertension Recognition, Treatment, and Control?
Background: Severe mental illness (SMI; bipolar disorder and schizophrenia) are associated with a 25-year decrease in lifespan, much of which is due to cardiovascular disease. SMI may delay the identification, treatment or control of hypertension (HT), in part due to competing demands for provider attention and the impact of SMI on patient adherence to HT treatment.
Objective: To test whether incident HT patients with SMI had worse HT recognition, treatment initiation and control than patients without SMI.
Methods: Insured patients 19 years of age and older with HT onset were identified from three large health systems from January 1, 2003 to December 31, 2008 based on combinations of elevated blood pressure readings (≥ 140/90 mmHg or ≥ 130/80 mmHg if diabetes or chronic kidney disease), HT diagnosis codes, and anti-HT prescription fills. SMI diagnoses were based on at least one inpatient or outpatient diagnosis code for bipolar disorder or schizophrenia. Comparison populations were 10:1 age- and gender-matched. Following HT onset, HT recognition was defined as the first HT diagnostic code, treatment initiation as the first HT medication fill, control as the second consecutive BP <140/90, and relapse as the second consecutive BP >140/90 following previous control. The crude and adjusted association between SMIs and HT outcome variables (incidence, recognition, treatment, and control) was examined with 12-month risk ratio (RR) estimates using Poisson regression models and hazard ratios (HR) estimated from 5-year follow-up using Cox-repression models.
Results: We identified 2267 HT patients with antecedent SMI. Compared to the HT patients without SMI, those with SMI were more likely to smoke, have diabetes, chronic kidney disease or cardiovascular disease, and made about one more medical visit per year. With covariate adjustment, at 12 months persons with SMI had slightly worse HT recognition and treatment initiation, but better HT control (bipolar RR=1.1, 95%CI:1.0-1.1; schizophrenia RR=1.1, 95%CI 1.0-1.2). There were no differences in HT relapse rates. Patients with SMI also had better HT control at 5-years (bipolar HR=1.12, 95% CI 1.05-1.20; schizophrenia HR=1.27, 95% CI 1.15-1.41).
Conclusion: Patients with SMI had better HT control than patients without SMI, even after adjusting for potential confounders including the number of medical encounters. Reasons for this unexpected finding should be explored.
- © 2013 by American Heart Association, Inc.