Diabetics Need Better
High Blood Pressure Control
Excerpt By Charnicia E. Huggins, Reuter's Health

NEW YORK (Reuters Health) - Many people with diabetes do not meet national recommendations for keeping their blood pressure under control, and new research may help explain why. Doctors may not be aggressive enough in treating high blood pressure, or hypertension, in people with diabetes, the results of a new study suggest.

"Our findings emphasize how clinicians need to be more aggressive in their management of blood pressure in diabetic patients with hypertension," lead study author Dr. Dan R. Berlowitz, of Bedford VA Hospital in Massachusetts, told Reuters Health.

Building upon previous research showing the importance of blood pressure control among people with diabetes, Berlowitz and his team investigated whether diabetic patients are achieving that control and whether doctors are treating high blood pressure among diabetics as intensely as they treat the condition among people without diabetes.

"While inadequate control of blood pressure is a national concern," the authors write, "it is particularly problematic among patients with diabetes."

The researchers analyzed medical records from 274 men with high blood pressure and diabetes and 526 men without diabetes. All of the men, who were military veterans, received regular medical care in New England between 1990 and 1995.

Overall, nearly three-quarters of the diabetics had blood pressure readings that were at least 140 millimeters of mercury (mm Hg) over 90 mm Hg or greater, the investigators report in the February issue of the journal Diabetes Care. Two-thirds of the non-diabetic patients had similarly high blood pressure.

Current national recommendations call for a target blood pressure that is below 130/85 mm Hg for people with high blood pressure and diabetes and below 140/90 mm Hg for people without diabetes.

Patients with diabetes also received much less intensive therapy for their high blood pressure than did those without diabetes, the report indicates. For example, diabetic patients were less likely than their peers to have been prescribed a new high blood pressure medication or an increased dosage in their existing medication, even when patients' age, race and other medical conditions were taken into consideration.

One reason for that less aggressive treatment, the researchers speculate, is that doctors were unfamiliar with the current guidelines. Another explanation may involve a phenomenon called "clinical inertia," which includes poorly trained doctors and doctors' overestimation of the intensity of care they provide.

Still, the results might be different today, since the current study's findings are based on data collected during the early to mid 1990s, the researchers note. Guidelines recommending a tighter level of blood pressure control for patients with a variety of risk factors for heart disease were not published until 1993, the report indicates.

Overall, however, "the message for patients is very clear," Berlowitz said. "They should be aware of their blood pressure, and if it is not at target--below 130/85--they should encourage their provider to provide additional care."

SOURCE: Diabetes Care 2003;26:355-359,534-535.

Reference Source 89

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