In treated but uncontrolled hypertension, RTGT improves control and lowers BP equally well or better than CHSC, indicating that RTGT provides a reasonable strategy for correcting treated but uncontrolled hypertension.

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Background/Aims: Microalbuminuria is a marker of abnormal vascular response and a predictor of cardiovascular morbidity and mortality. We evaluated a new quantitative office-based method to assess urinary albumin excretion (UAE) and compared it to other established methods. Methods: Spot urine samples from 165 patients were analyzed at a single study site using the HemoCue system, Clinitek Microalbumin, and Chemstrip Micral test, as well as at a central laboratory, where UAE and creatinine levels were measured. The central laboratory UAE values were used as reference. We evaluated the validity of the HemoCue results and compared them to the respective data for the laboratory albumin-to-creatinine ratio (ACR). Additionally, we assessed, diagnostic sensitivity, specificity, and positive and negative predictive values of all four methods, as well as the reproducibility of the HemoCue measurements. Results: Linear regression analysis demonstrated a good correlation for the HemoCue system (y = 0.9978x – 1.0217, R² = 0.904) and ACR (y = 0.0815x + 0.3373, R² = 0.784). Sensitivity and specificity for microalbuminuria diagnosis were 92 and 98% for HemoCue, 73 and 96% for ACR, 100 and 81% for Clinitek Microalbumin, and 70 and 83% for Chemstrip Micral dipstick, respectively. The correlation coefficient of duplicate HemoCue measurements was r = 0.98 (p < 0.001). Conclusions: The HemoCue system for microalbuminuria detection was as accurate and precise as laboratory ACR estimations. Its diagnostic performance was much better than that of widely used dipstick methods.

Among diabetic hypertensive patients, ethnic differences in blood pressure control and outcomes have been attributed in part to greater reluctance of providers to prescribe combination antihypertensive regimens to African Americans than to Caucasians. African Americans purportedly receive fewer angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs), which reduce target organ complications. To assess these issues, cross-sectional data were analyzed from 19,864 diabetic hypertensives from 62 primary care clinics. Among diabetic hypertensives, African Americans (N=6230) were less likely than Caucasians (N=8041) to have blood pressure (BP) <130/80 mm Hg at their last clinic visit (23.1% [23.0%-23.2%] vs. 30.7% [30.6%-30.9%]) despite a greater number of prescriptions for antihypertensive medications (2.67 [2.63-2.70] vs. 2.23 [2.20-2.26]). African Americans were more likely than Caucasians to have an ACEI and/or ARB prescribed and to receive prescriptions for at least two antihypertensive medications that included an ACEI or ARB (64.1% [63.8%-64.4%] vs. 53.1% [52.8%-53.4%]). Among diabetic hypertensives, African Americans are less likely than Caucasians to attain BP <130/80 mm Hg, despite receiving more antihypertensive medication prescriptions. African Americans receive more ACEIs and/or ARBs than Caucasians for target organ protection and/or BP control. The data suggest provider prescribing patterns are not a major contributor to ethnic differences in BP control and outcomes in diabetic hypertensives.

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