Increased Morbidity and Mortality in Hypertensive Patients With Substance Use Disorders: Electronic Health Record Findings

Objective: Substance use disorder (SUD) management by medical providers may be important for patients with comorbid health conditions exacerbated by SUD. This study evaluated potential associations of SUD with morbidity and mortality in a large sample of hypertensive patients. Method: Analysis of a limited data set was obtained through IBM Watson Health Explorys, a platform integrating data from electronic health records. Matched controls were defined for each of five SUDs: tobacco use disorder (TUD), alcohol use disorder (AUD), cocaine use disorder (COUD), opioid use disorder (OUD), and cannabis use disorder (CUD) using Mahalanobis distance within propensity score calipers. All patients were from The MetroHealth System (Cleveland, OH) and had diagnosed hypertension. SUD group participants had diagnosed abuse/dependence for the substance of interest. Controls for each SUD group had no diagnosis code related to the substance of interest and were selected to match the SUD patients on several factors. Total sample sizes for each SUD-control comparison ranged from 3,176 (CUD) to 49,696 (TUD); proportions of female patients ranged from 31.7% (AUD) to 51.2% (TUD). Outcomes were diagnosis (yes/no) of the following: cerebrovascular accident, myocardial infarction, renal failure, and all-cause mortality. Results: Logistic regressions revealed that SUD was significantly associated with cerebrovascular accident (odds ratios [ORs]: TUD = 2.23; AUD = 1.68; COUD = 2.53; OUD = 1.87; CUD = 2.20), renal failure (ORs: TUD = 1.46; COUD = 2.09; OUD = 1.77), myocardial infarction (ORs: TUD = 2.96; AUD = 1.92; COUD = 3.00), and mortality (ORs: TUD = 1.34; AUD = 1.60; COUD = 1.83; OUD = 1.35; CUD = 1.39). Conclusions: Among patients with hypertension, those with SUDs appear to have significantly greater risk for morbidity and mortality, suggesting the importance of managing SUD in hypertensive patients.