Hypertension Management in Patients With Diabetes

Hypertension Management in Patients With Diabetes The need for more aggressive therapy Dan R. Berlowitz , MD, MPH 1 2 , Arlene S. Ash , PHD 2 3 , Elaine C. Hickey , RN, MS 1 2 , Mark Glickman , PHD 3 , Robert Friedman , MD 2 3 and Boris Kader , PHD 1 1 Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts 2 Boston University Schools of Public Health and Medicine, Boston, Massachusetts 3 Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts 4 Department of Mathematics, Boston University, Boston, Massachusetts Abstract OBJECTIVE —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. RESEARCH DESIGN 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 mmHg, 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 pressur