title: Patients' body mass index and blood pressure over time: diagnoses, treatments, and the effects of comorbidities.
abstract: BACKGROUND
  A national strategic framework to address multiple chronic conditions has called for further research on disease trajectories of patients with comorbidities.
  
  
  METHODS
  An observational study using multilevel models to analyze electronic health record data from a multispecialty practice from 2003 to 2010 to examine disease trajectories of patients with at least 2 of 3 common chronic conditions: overweight/obese, hypertension, and depression. Using longitudinal data on up to 110,000 patients, the effects of comorbidities on the probability of having a diagnosis for overweight/obesity or hypertension and on the trajectories of body mass index (BMI) and blood pressure (BP) over time were examined.
  
  
  RESULTS
  From 2003 to 2010, the percentage of patients with high BMI receiving an overweight/obesity diagnosis grew from 5.0% to 18.7%, and the percentage of patients with high BP having a hypertension diagnosis rose from 39.9% to 51.7%. The effect of time for patients with high BMI and depression was less than the effect of time for high BMI only patients (P<0.01) in receiving overweight/obesity diagnoses. Co-occurring depression and high BMI was positively associated with BMI trajectory (coefficient=0.06, P<0.01), whereas high BP and high BMI (coefficient=-0.07, P<0.01) or high BP and high BMI and depression (coefficient=-0.05, P<0.01) were negatively associated with BMI trajectories.
  
  
  CONCLUSIONS
  Although physicians' recording of diagnoses for patients with high BMI and high BP has improved, significant gaps remain. Some co-occurrence patterns of these 3 conditions not only affected the recognition of overweight/obesity and hypertension over time, but also BMI trajectories over time. Quality improvement efforts should target patients with co-occurring depression and overweight/obesity.
authors.affiliation: *Palo Alto Medical Foundation Research Institute, Mountain View †Palo Alto Medical Foundation, Palo Alto, CA.
authors.forename: Ming
authors.initials: M
authors.lastname: Tai-Seale
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Wilson
authors.forename: Ashley
authors.initials: A
authors.lastname: Stone
authors.forename: Meg
authors.initials: M
authors.lastname: Durbin
authors.forename: Harold S
authors.initials: HS
authors.lastname: Luft
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015984:Causality; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology*; D015340:Epidemiologic Research Design; D005260:Female; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology