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‚ÄčThe CVRN Hypertension Study

Hypertension


Leadership: 

Alan S. Go, MD, Principal Investigator Kaiser Permanente Northern California
David Magid MD, Co-Investigator Kaiser Permanente Colorado
Karen Margolis MD, MPH, Co-Investigator HealthPartners Institute for Education and Research
Patrick O`Connor MD, MA, MPH, Co-Investigator HealthPartners Institute for Education and Research

Study Summary
The CVRN Hypertension Dataset consist of adult patients with hypertension. Patients were included in the dataset if they met one of the following categories of hypertension between January 1, 2000 and December 31, 2009:

  • Recognized hypertension defined as:
    • Two diagnoses of hypertension at a non-urgent ambulatory visit on separate dates, or
    • One diagnosis of hypertension and at least one dispensing of an anti-hypertensive medication, or
    • One diagnosis of hypertension and at least one elevated outpatient blood pressure at a non-urgent ambulatory visit.
  • Unrecognized hypertension defined as:
    • Two or more consecutive elevated blood pressures at non-urgent ambulatory visits on separate dates without an accompanying hypertension diagnosis or hypertension treatment.

The dataset is comprised of data across three participating sites: Kaiser Permanente Northern California (KPNC), Kaiser Permanente Colorado (KPCO), and HealthPartners Institute for Education and Research (HPIER).
Population
The CVRN hypertension cohort consists of nearly 1.75 million patients aged 18 years or older across the participating sites.  KPNC enrolled 1,286,274 members, KPCO 211,194 members, HPIER 248, 373 members.

Table 1. CVRN Hypertension Dataset Member Counts by Site


Site

Number of Members

Percent of Dataset

Kaiser Permanente Northern California

1,286,274

73.7%

Kaiser Permanente Colorado

211,194

12.1%

HealthPartners Institute

248,373

14.2%

Total

1,745,841

100.0%

Cohort Characteristics
Of the 1,286,274 KPNC members, 51% qualified for entry with a hypertension diagnosis and hypertension medication. 43% qualified for entry with two consecutive elevated blood pressure measurements. 43% qualified for entry with two consecutive elevated blood pressures. 34% qualified for entry with a hypertension diagnosis and elevated blood pressure measurement. And 3% qualified for entry with two hypertension diagnosis.
Of the 211,194 KPCO members 42% qualified for entry with a hypertension diagnosis and hypertension medication. 50% qualified for entry with two consecutive elevated blood pressure measurements. 32% qualified for entry with a hypertension diagnosis and an elevated blood pressure measurement. 6% qualified for entry with two hypertension diagnoses.
Of the 248,373 HPIER members 63% qualified for entry with a hypertension diagnosis and hypertension medication. 19% qualified for entry with two consecutive elevated blood pressure measurements. 12% qualified with a hypertension diagnosis and an elevated blood pressure measurement. 15% qualified with two hypertension diagnoses.

Figure 1. Proportion of CVRN Hypertension Dataset Members with at Least One Blood Pressure in Electronic Medical Record, by Year and Site
Proportion of CVRN Hypertension Dataset Members with at Least One Blood Pressure in Electronic Medical Record, by Year and Site

(HPIER-Filtered: a subset of the population that visited an HPIER-owned clinic during the year of their superset entry)

Figure 2. Distribution of Entry Criteria by Site in CVRN Hypertension Dataset

Percentage of site HTN Registry Population
Figure 2 Legend
DXRX= HTN Diagnosis + Medication
2EBP= Two consecutive Elevated Blood Pressures 
DXEBP= HTN Diagnosis + EBP
2DX= Two HTN Diagnoses

Figure 3. Distribution of Age and Gender by Site in CVRN Hypertension Dataset

Percentage of site HTN Registry Population

Data Source
All member data was extracted using the Virtual Data Warehouse (VDW). The VDW is a standardized resource comprised of: (1) computerized datasets stored behind separate security firewalls, including variables with identical names, formats, and specifications; (2) informatics tools that facilitate storage, retrieval, processing, and managing the datasets; and (3) detailed data documentation. All data are linked by a unique identifier so that data elements can be rolled up to the individual person-level. The three sites included in the CVRN Hypertension Dataset have different business models that are important when planning analyses or cohort selections.

  • KPNC has nearly 100% traditional group-model membership, meaning nearly all of their members have a complete spectrum of data during their enrollment. KPNC owns its own hospitals and clinics so that most data sources are from internal data systems rather than outside claims.
  • KPCO owns the outpatient clinics where members receive most of their care, but it does not own hospitals. Therefore, inpatient data, hospitals ambulatory, and certain types of specialty visits with outside providers come in through claims systems.
  • HPIER has an open network model, resulting in a mix of clinic usage patterns, and does not have specific plan types to identify these patterns. Their model has about 1/3 members with electronic medical record data, and members can come in and out of the owned clinic system at any time.

Key Publications
Byrd JB, Powers JD, Magid DJ, Tavel HM, Schmittdiel JA, O'Connor PJ, Beck AL, Butler MG, Ho PJ. Detection and recognition of hypertension in anxious and depressed patients. J Hypertens. Epub 4 Oct 2012.

Byrd JB, Zeng C, Tavel HM, Magid DJ, O'Connor PJ, Margolis KL, Selby JV, Ho PM. Combination therapy as initial treatment for newly diagnosed hypertension. Am Heart J 2011;162:340-6.

Daugherty SL, Masoudi FA, Ellis JL, Ho PM, Schmittdiel JA, Tavel HM, Selby JV, O'Connor PJ, Margolis KL, Magid DJ. Age-dependent gender differences in hypertension management. J Hypertens 2011;29:1005-11.

Daugherty SL, Powers JD, Magid DJ, Masoudi FA, Margolis KL, O'Connor PJ, Schmittdiel JA, Ho PM. The association between medication adherence and treatment intensification with blood pressure control in resistant hypertension. Hypertension 2012;60:303-9.

Daugherty SL, Powers JD, Magid DJ, Tavel HM, Masoudi FA, Margolis KL, O'Connor PJ, Selby JV, Ho PM. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation 2012;125:1635-42.

Fang MC, Go AS, Chang Y, Borowsky LH, Pomernacki NK, Udaltsova N, Singer DE. A new risk scheme to predict warfarin-associated hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am Coll Cardiol 2011;58:395-401.

Go AS, Magid DJ, Wells B, Sung SH, Cassidy-Bushrow AE, Greenlee RT, Langer RD, Lieu TA, Margolis KL, Masoudi FA, McNeal CJ, Murata GH, Newton KM, Novotny R, Reynolds K, Roblin DW, Smith DH, Vupputuri S, White RE, Olson J, Rumsfeld JS, Gurwitz JH. The Cardiovascular Research Network: a new paradigm for cardiovascular quality and outcomes research. Circ Cardiovasc Qual Outcomes 2008;1:138-47.

Hanratty R, Chonchol M, Havranek EP, Powers JD, Dickinson LM, Ho PM, Magid DJ, Steiner JF. Relationship between blood pressure and incident chronic kidney disease in hypertensive patients. Clin J Am Soc Nephrol 2011;6:2605-11.

Ho PM, Magid DJ, Shetterly SM, Olson KL, Peterson PN, Masoudi FA, Rumsfeld JS. Importance of therapy intensification and medication nonadherence for blood pressure control in patients with coronary disease. Arch Intern Med 2008;168:271-6.

 Ho PM, Zeng C, Tavel HM, Selby JV, O'Connor PJ, Margolis KL, Magid DJ. Trends in first-line therapy for hypertension in the Cardiovascular Research Network Hypertension Registry, 2002-2007. Arch Intern Med 2010;170:912-3.
Maddox TM, Ross C, Tavel HM, Lyons EE, Tillquist M, Ho PM, Rumsfeld JS, Margolis KL, O'Connor PJ, Selby JV, Magid DJ. Blood pressure trajectories and associations with treatment intensification, medication adherence, and outcomes among newly diagnosed coronary artery disease patients. Circ Cardiovasc Qual Outcomes 2010;3:347-57.

Magid DJ, Shetterly SM, Margolis KL, Tavel HM, O'Connor PJ, Selby JV, Ho PM. Comparative effectiveness of angiotensin-converting enzyme inhibitors versus beta-blockers as second-line therapy for hypertension. Circ Cardiovasc Qual Outcomes 2010;3:453-8.

Parker ED, Margolis KL, Trower NK, Magid DJ, Tavel HM, Shetterly SM, Ho PM, Swain BE, O'Connor PJ. Comparative Effectiveness of 2 beta-Blockers in Hypertensive Patients. Arch Intern Med 2012:1-7.

Schmittdiel J, Selby JV, Swain B, Daugherty SL, Leong TK, Ho M, Margolis KL, O'Connor P, Magid DJ, Bibbins-Domingo K. Missed opportunities in cardiovascular disease prevention?: low rates of hypertension recognition for women at medicine and obstetrics-gynecology clinics. Hypertension 2011;57:717-22.

Selby JV, Lee J, Swain BE, Tavel HM, Ho PM, Margolis KL, O'Connor PJ, Fine L, Schmittdiel JA, Magid DJ. Trends in time to confirmation and recognition of new-onset hypertension, 2002-2006. Hypertension 2010;56:605-11.

Steiner JF, Ho PM, Beaty BL, Dickinson LM, Hanratty R, Zeng C, Tavel HM, Havranek EP, Davidson AJ, Magid DJ, Estacio RO. Sociodemographic and clinical characteristics are not clinically useful predictors of refill adherence in patients with hypertension. Circ Cardiovasc Qual Outcomes 2009;2:451-7.

Tavel H, Defor T, Swain B, Schneider N, Lee J, Shetterly S, O'Connor P, Selby J, Magid D. C-C1-01: Building the Hypertension Registry: Adventures in Using the VDW Model. Clin Med Res 2010;8:188-9.


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