Vol 4, No 2 (2003): Practical Diabetology
Other materials agreed with the Editors
Published online: 2003-04-28
Hypertension management in patients with diabetes. The need for more aggressive therapy
Diabetologia Praktyczna 2003;4(2):161-168.
Abstract
INTRODUCTION. Clinical trials have demonstrated the
importance of tight blood pressure control among
patients with diabetes. However, little is known regarding
the management of hypertension in patients
with coexisting diabetes. To examine this issue, we
addressed 1) whether hypertensive patients with
coexisting diabetes are achieving lower levels of blood
pressure than patients without diabetes, 2) whether
there are differences in the intensity of antihypertensive
medication therapy provided to patients
with and without diabetes, and 3) whether diabetes
management affects decisions to increase antihypertensive
medication therapy.
MATERIAL AND METHODS. We abstracted medical records to collect detailed information on 2 years of care provided for 800 male veterans with hypertension. We compared patients with and without diabetes on intensity of therapy and blood pressure control. Intensity of therapy was described using a previously validated measure that captures the likelihood of an increase in antihypertensive medications. We also determined whether increases in antihypertensive medications were less likely at those visits in which the diabetes medications were being adjusted.
RESULTS. Of the 274 hypertensive patients with diabetes, 73% had a blood pressure 140/90 mm Hg, compared with 66% in the 526 patients without diabetes (P = 0.04). Diabetic patients also received significantly (P = 0.05) less intensive antihypertensive medication therapy than patients without diabetes. Less intensive therapy in diabetic patients could not be explained by clinicians being distracted by the treatment for diabetes.
CONCLUSIONS. There is an urgent need to improve hypertension care and blood pressure control in patients with diabetes. Additional information is required to understand why clinicians are not more aggressive in managing blood pressure when patients also have diabetes.
MATERIAL AND METHODS. We abstracted medical records to collect detailed information on 2 years of care provided for 800 male veterans with hypertension. We compared patients with and without diabetes on intensity of therapy and blood pressure control. Intensity of therapy was described using a previously validated measure that captures the likelihood of an increase in antihypertensive medications. We also determined whether increases in antihypertensive medications were less likely at those visits in which the diabetes medications were being adjusted.
RESULTS. Of the 274 hypertensive patients with diabetes, 73% had a blood pressure 140/90 mm Hg, compared with 66% in the 526 patients without diabetes (P = 0.04). Diabetic patients also received significantly (P = 0.05) less intensive antihypertensive medication therapy than patients without diabetes. Less intensive therapy in diabetic patients could not be explained by clinicians being distracted by the treatment for diabetes.
CONCLUSIONS. There is an urgent need to improve hypertension care and blood pressure control in patients with diabetes. Additional information is required to understand why clinicians are not more aggressive in managing blood pressure when patients also have diabetes.
Keywords: hypertensiondiabetes mellitus