open access

Vol 4, No 2 (2003): Practical Diabetology
Original articles (translated)
Published online: 2003-04-28
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Hypertension management in patients with diabetes. The need for more aggressive therapy

Dan R. Berlowitz, Arlene S. Ash, Elaine C. Hickey, Mark Glickman, Robert Friedman, Boris Kader
Diabetologia Praktyczna 2003;4(2):161-168.

open access

Vol 4, No 2 (2003): Practical Diabetology
Original articles (translated)
Published online: 2003-04-28

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.

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.
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Keywords

hypertension; diabetes mellitus

About this article
Title

Hypertension management in patients with diabetes. The need for more aggressive therapy

Journal

Clinical Diabetology

Issue

Vol 4, No 2 (2003): Practical Diabetology

Pages

161-168

Published online

2003-04-28

Bibliographic record

Diabetologia Praktyczna 2003;4(2):161-168.

Keywords

hypertension
diabetes mellitus

Authors

Dan R. Berlowitz
Arlene S. Ash
Elaine C. Hickey
Mark Glickman
Robert Friedman
Boris Kader

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