{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T03:56:54Z","timestamp":1763179014258,"version":"3.37.3"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2017,8,14]],"date-time":"2017-08-14T00:00:00Z","timestamp":1502668800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01-AG017473","R01-AG046860","P01-AG043352"],"award-info":[{"award-number":["R01-AG017473","R01-AG046860","P01-AG043352"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,1,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>BACKGROUND<\/jats:title>\n                  <jats:p>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).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>IDT was associated with increased risk of CHF (HR 2.32; 95% confidence interval (CI) 2.32\u20132.38), MI (HR 4.27; 95% CI 4.05\u20134.52), and stroke or TIA (HR 1.80; 95% CI 1.70\u20131.89) but decreased risk of death (HR 0.95; 95% CI 0.93\u20130.97). Risk for CHF (HR 0.73; 95% CI 0.71\u20130.73), MI (HR 0.64; 95% CI 0.62\u20130.67), stroke or TIA (HR 0.82; 95% CI 0.78\u20130.86), and death (HR 0.29; 95% CI 0.28\u20130.29) was decreased by adherence to diabetes management guidelines.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajh\/hpx151","type":"journal-article","created":{"date-parts":[[2017,8,10]],"date-time":"2017-08-10T11:10:37Z","timestamp":1502363437000},"page":"220-227","source":"Crossref","is-referenced-by-count":10,"title":["Mortality and Macrovascular Risk in Elderly With Hypertension and Diabetes: Effect of Intensive Drug Therapy"],"prefix":"10.1093","volume":"31","author":[{"given":"Arseniy P","family":"Yashkin","sequence":"first","affiliation":[{"name":"Biodemography of Aging Research Unit, Center for Population Health and Aging, Duke University, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Kravchenko","sequence":"additional","affiliation":[{"name":"Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anatoliy I","family":"Yashin","sequence":"additional","affiliation":[{"name":"Biodemography of Aging Research Unit, Center for Population Health and Aging, Duke University, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Sloan","sequence":"additional","affiliation":[{"name":"Department of Economics, Duke University, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2017,8,14]]},"reference":[{"key":"2022111503485866800_CIT0001","first-page":"146","article-title":"Factors contributing to medication noncompliance in elderly public housing tenants","volume":"20","author":"Murray","year":"1986","journal-title":"Drug Intell Clin Pharm"},{"key":"2022111503485866800_CIT0002","doi-asserted-by":"crossref","first-page":"28","DOI":"10.15256\/joc.2011.1.4","article-title":"Multiple diseases and polypharmacy in the elderly: challenges for the internist of the third millennium","volume":"1","author":"Nobili","year":"2011","journal-title":"J Comorb"},{"key":"2022111503485866800_CIT0003","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.cger.2014.08.017","article-title":"Antidiabetic medications and polypharmacy","volume":"31","author":"Peron","year":"2015","journal-title":"Clin Geriatr Med"},{"key":"2022111503485866800_CIT0004","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1111\/j.1559-4564.2007.06368.x","article-title":"Diabetes and hypertension: epidemiology of the relationship and pathophysiology of factors associated with these comorbid conditions","volume":"2","author":"Schutta","year":"2007","journal-title":"J Cardiometab Syndr"},{"key":"2022111503485866800_CIT0005","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/MLR.0000000000000309","article-title":"Causes of the change in the rates of mortality and severe complications of diabetes mellitus: 1992-2012","volume":"53","author":"Yashkin","year":"2015","journal-title":"Med Care"},{"volume-title":"National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014","year":"2014","author":"CDC","key":"2022111503485866800_CIT0006"},{"key":"2022111503485866800_CIT0007","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/1477-7525-7-82","article-title":"Prevalence of multiple chronic conditions in the United States\u2019 Medicare population","volume":"7","author":"Schneider","year":"2009","journal-title":"Health Qual Life Outcomes"},{"key":"2022111503485866800_CIT0008","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1053\/ajkd.2000.16225","article-title":"Preserving renal function in adults with hypertension and diabetes: a consensus approach. 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