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Substance Use Disorder May Increase Risk of Stroke, Heart Attack, Renal Failure, or Death in Patients with Hypertension

January 10, 2020
Meg Brunner, MLIS
Citation: Winhusen T, et al. Increased morbidity and mortality in hypertensive patients with substance use disorders: Electronic health record findings. Journal of Studies on Alcohol and Drugs 2020;81:471-478. 
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As general medical settings increasingly work to integrate substance use disorder (SUD) screening and management, being able to prioritize these practices for patients with medical conditions exacerbated by SUD may help facilitate adoption. Hypertension impacts over a quarter of American adults, yet despite the prevalence and cost of this condition, not much research has been done to examine the relationship between it and SUD.

This study evaluated potential associations of SUD with morbidity and mortality in a large sample of hypertensive patients. Analysis of a limited data set was obtained through IBM Watson Health Explorys, a platform that integrates data from electronic health records. Matched controls were defined for use disorders for five substances: tobacco, alcohol, cocaine, opioids, and cannabis.



All patients had a diagnosis of hypertension and were from the same health system in the same city (Cleveland, OH; CTN Ohio Valley Node). Those in the SUD group had diagnosed abuse/dependence for the substance of interest. Those in the control group had no diagnosis code related to the substance of interest and were selected to match the SUD patients on several factors.

Outcomes were diagnosis (yes/no) of the following: 


  • cerebrovascular accident (stroke) 
  • myocardial infarction (heart attack) 
  • renal failure 
  • all-cause mortality 

Analysis revealed that those with an SUD were at significantly greater risk for all 4 of those outcomes, including death. Those with tobacco or cocaine use disorder were at greater risk for all 4 outcomes. Those with alcohol use disorder were more likely to experience stroke, heart attack, and all-cause mortality. Patients with diagnosed opioid use disorder were at significantly greater risk for stroke and all-cause mortality, but not for heart attack. And individuals with cannabis use disorder were at significantly greater risk for stroke and all-cause mortality. Some of these results contradict previous studies and the correlations between these substances and outcomes need to be studied further.

Conclusions: These results suggest that in hypertensive patients, those with an SUD may be at significantly greater risk for several hypertension-related adverse medical events and overall mortality. Future research to replicate this finding and to delineate the possible ways in which SUD may impact these outcomes is warranted.

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