PI-127 - EFFECT OF HYPERTENSION (HTN) AND BLOOD PRESSURE (BP) CONTROL ON CARDIOVASCULAR OUTCOMES IN PATIENTS WITH ALZHEIMER'S DISEASE AND RELATED DEMENTIA (ADRD) WITHIN THE STATE OF FLORIDA USING ELECTRONIC HEALTH RECORD (EHR)-BASED DATA.

E. Jafari^1,2, M. Alshahawey^3,4, Y. Gong⁵, G. Smith⁶, S. Smith⁷, C. McDonough⁸; ¹Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida., Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida., USA, ²Department of Pharmacy Practice, College of Pharmacy, Jazan University, Jazan, Saudi Arabia., ³Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida., USA, ⁴Department of Clinical Pharmacy, College of Pharmacy, Ain Shams University, Cairo, Egypt, ⁵University of Florida, GNV, United States, ⁶Univeristy of Florida, Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States, ⁷Univeristy of Florida, Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, United States, ⁸University of Florida, Gainesville, FL, USA.

Background: Patients with ADRD and HTN have a higher risk for adverse cardiovascular (CV) outcomes, compared to those without HTN, but the impacts of BP control on adverse CV outcomes in these patients has been less explored

Methods: Using data from the OneFlorida Data Trust (2012-2022), we identified adult patients with ADRD using a validated algorithm. Within this cohort, we used validated HTN computable phenotypes to identify HTN control (apparent treatment-resistant HTN [aTRH], and non-resistant HTN with well-controlled BP [>80% of visits], intermediate-controlled BP [80-50%], uncontrolled BP [ < 50%], and without HTN) during an 18 month period following ADRD index diagnosis. Cox regression was used to evaluate time to first occurrence of the CV outcome (composite of myocardial infarction and stroke, defined using validated ICD codes). Subgroup analyses were conducted by age

Results: 9,430 ADRD patients were included in the analysis: 3,523 without HTN, 1,295 with well-controlled HTN, 986 with intermediate-controlled HTN, 844 with uncontrolled HTN, and 2,782 with aTRH. Compared to ADRD patients without HTN, patients with uncontrolled HTN showed the highest risk of CV outcomes, hazard ratio (HR): 1.96 (95% CI 1.54-2.51, Table). Patients with other HTN phenotypes, including aTRH, also showed increased CV risk (HRs: 1.31-1.53, Table). In patients < 75 years old, we observed similar results (Table). However, in patients ≥75 while we observed similar results in the well-controlled, intermediate-controlled, and uncontrolled HTN patients, we did not observe a significant increased risk for CV outcomes in aTRH patients (Table, HTN phenotype – age group interaction P=0.18). When the aTRH group was split into patients with uncontrolled HTN prescribed 3 antiHTN medications and controlled HTN patients prescribed ≥4 antiHTN medications, patients with uncontrolled aTRH prescribed 3 antiHTN medications showed a consistent non-significant trend of higher risk for CV outcomes (HR: 1.23, 95% CI 0.88-1.74)

Conclusion: In older ADRD patients with HTN, our results suggest that the level of BP control, as opposed to the high-risk HTN phenotype of aTRH, may have a stronger influence on a patients CV outcome risk. This highlights the importance of maintaining BP control, regardless of the number of BP classes required, for mitigating CV outcomes in older ADRD patients