Abstract
Background/Aims Hypertension (HTN), overweight and/or obesity (OVRWT), and depression (DEP) frequently co-occur. Research on co-occurring chronic conditions often relies on Medicare claims data, and is subject to biases from age limits and reliance on claims-based diagnoses. We use electronic health record (EHR) data from a multispecialty practice to study the occurrence of these conditions among all adults. We assess the probability that previously untreated patients with high blood pressure (BP) receive a diagnosis and subsequently are treated with drugs, and the impact of such treatment on both the BP and body mass index (BMI) of people who also have OVRWT and/or DEP.
Methods EHR data for 2002–2010 were used to examine BP and BMI trajectories among adults with HTN, OVRWT, or DEP and to examine the impact of prescriptions for HTN and DEP on trends in BP and BMI, controlling for patient characteristics. We used propensity score stratification to address treatment selection bias.
Results Most (71%; 23,806/33,326) people with any of these 3 conditions were aged <65. About 32% (21,166/66,552) of those with high BP were neither diagnosed nor treated for HTN. Only 53% (14,254/27,016) of obese patients had a weight-related diagnosis. Recorded depression was associated with increases over time in BP (coeff = .09, P <.01) and BMI (coeff = .06, P <.01), but hypertension was associated with slower increases in BMI (coeff = −.08, P<.01). With propensity score stratification, growth curve modeling revealed antihypertensive treatment to be associated with declines in both BP and BMI. Depression medications were not significantly associated with BP or BMI changes.
Conclusions Less than two-thirds of the patients with elevated BPs were diagnosed as having HTN. The favorable impact of HTN treatment on BMI, as well as on BP, suggests addressing missed opportunities for treatment can potentially lead to better outcomes for patients with both problems.
