Appropriate Blood Pressure Control in NIDDM (ABCD) Trial

Schrier, Robert W.; Estacio, Raymond O.; Jeffers, Barrett W.

doi:10.1007/s001250050629

Cited by 85 publications

(31 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In recent years, A1c levels have improved with the increased availability of more effective pharmacologic agents including new insulins, metformin, and thiazolidinediones, with marked A1c improvement noted in some care settings (13)(14)(15)(16). Similarly, more effective pharmacologic strategies have been developed and disseminated for the primary and secondary prevention of cardiovascular disease, and studies have shown that the use of statins (17,18), fibrates (19), ACE inhibitors (20), and more aggressive control of hypertension (21,22) reduce cardiovascular morbidity and mortality in those with diabetes. Data show that A1c levels tend to rise with duration of diabetes (23), and the prevalence of depressive symptoms appears to be increased among those with diabetes (24) due to several factors (25)(26)(27).…”

mentioning

confidence: 99%

Predictors of Health Care Costs in Adults With Diabetes

et al. 2005

View full text Add to dashboard Cite

OBJECTIVE -The purpose of this study was to assess the impact of baseline A1c, cardiovascular disease, and depression on subsequent health care costs among adults with diabetes. RESEARCH DESIGN AND METHODS-A prospective analysis was performed of data from a patient survey and medical record review merged with 3 years of medical claims. Costs were estimated using detailed data on resource use and Medicare payment methodologies. Generalized linear models were used to analyze costs related to clinical predictors after adjusting for demographic and socioeconomic factors.RESULTS -In multivariate analysis of 1,694 adults with diabetes, 3-year costs in those with coronary heart disease (CHD) and hypertension were over 300% of those with diabetes only ($46,879 vs. $14,233; P Ͻ 0.05). Depression was associated with a 50% increase in costs ($31,967 vs. $21,609; P Ͻ 0.05). Relative to those with a baseline A1c of 6%, those with an A1c of 10% had 3-year costs that were 11% higher ($26,408 vs. $23,873; P Ͻ 0.05). Higher A1c predicted higher costs only for those with baseline A1c Ͼ7.5% (P ϭ 0.015).CONCLUSIONS -In adults with diabetes, CHD, hypertension, and depression spectrum disorders more strongly predicted future costs than the A1c level. Concurrent with aggressive efforts to control glucose, greater efforts to prevent or control CHD, hypertension, and depression are necessary to control health care costs in adults with diabetes. Diabetes Care 28:59 -64, 2005A dults with diabetes experience significantly higher health care costs than sex-and age-matched adults without diabetes (1-5). This increased use of resources is related to a broad range of factors including higher outpatient costs, higher pharmaceutical costs, higher rates of hospitalization, and longer hospital stays during admissions related to many diagnoses (6). Cardiovascular disease accounts for about 70% of deaths in adults with diabetes, and several studies show that cardiovascular disease is a major driver of costs in diabetes patients (7-10).A substantial body of research on diabetes management has focused on glycemic control. Large randomized controlled trials have shown that aggressive management of A1c reduces the risk of microvascular complications in patients with type 1 and type 2 diabetes (11,12). In earlier work, we examined medical charges related to A1c and found that after controlling for demographics and cardiovascular disease, charges rose by ϳ30% as A1c increased from 6 to10%. In the same study subjects, after controlling for A1c, sex, and age, those with heart disease and hypertension had charges over 400% of those with diabetes alone. At the time, we concluded that cardiovascular disease was a stronger predictor of resource use in adults with diabetes than was the level of glycemic control (8).Our previous analysis was conducted using data from 1992 to 1996, in an era when glycemic control was generally worse than it is now. In recent years, A1c levels have improved with the increased availability of more effective pharmacologic agents incl...

show abstract

mentioning

confidence: 99%

Predictors of Health Care Costs in Adults With Diabetes

et al. 2005

View full text Add to dashboard Cite

show abstract

“…here is extensive clinical evidence linking hypertension with microand macrovascular complications of diabetes, including randomized controlled trials and a meta-analysis (1)(2)(3)(4)(5)(6). Until 2000, the target blood pressure for individuals with diabetes was the same as that for individuals without diabetes (Ͻ140/90 mmHg).…”

mentioning

confidence: 99%

Action or Inaction? Decision Making in Patients With Diabetes and Elevated Blood Pressure in Primary Care

Hicks¹,

Westfall

Vorst

et al. 2006

Diabetes Care

View full text Add to dashboard Cite

OBJECTIVE -Hypertension increases micro-and macrovascular complications of diabetes. The goal for blood pressure is Ͻ130/80 mmHg. In primary care, however, blood pressure in many patients exceeds this goal. In this study, we evaluated the clinical decision-making process when a patient with diabetes presents with elevated blood pressure.RESEARCH DESIGN AND METHODS -Twenty-six primary care practices in two practice-based research networks in Colorado participated. Questionnaires were completed after each encounter with an adult with type 2 diabetes. Data obtained from the survey included 1) demographic information, 2) blood pressure results, 3) action taken, 4) type of action if action was taken, and 5) reasons for inaction if action was not taken. Bivariate and multivariate analyses were performed to identify predictors of action.RESULTS -Completed surveys totaled 778. Blood pressure was 130/74 Ϯ 18.8/12.0 mmHg (mean Ϯ SD). Sixty-two percent of patients exceeded goals. Action was taken to lower blood pressure in 34.9% of those. Predictors of action were 1) blood pressure level, 2) total number of medicines the patient was taking, and 3) patient already taking medicines for blood pressure. As blood pressure rose, providers attributed inaction more often to "competing demands" and reasons other than "blood pressure being at or near goal." CONCLUSIONS -No evidence was found for patterns of poor care among primary care physicians. Providers balance the clinical circumstances, including how elevated the blood pressure is, and issues of polypharmacy, medication side effects, and costs when determining the best course of action. Knowledge deficit is not a common cause of inaction. Diabetes Care 29:2580 -2585, 2006T here is extensive clinical evidence linking hypertension with microand macrovascular complications of diabetes, including randomized controlled trials and a meta-analysis (1-6). Until 2000, the target blood pressure for individuals with diabetes was the same as that for individuals without diabetes (Ͻ140/90 mmHg). However, because of the demonstrated clinical benefit of lower blood pressure specifically for diabetes, national guidelines, established by the American Diabetes Association and the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), call for more intensive management, with a target of Ͻ130/80 mmHg (7,8).Of the care provided to patients with type 2 diabetes, ϳ90% takes place in primary care practices (9). Unfortunately, blood pressure control in these settings is frequently suboptimal (10 -12) and may be even worse in those with diabetes and hypertension compared with those with hypertension alone (13).An essential component of lowering blood pressures to goal is the clinical decision made by the primary care provider at the visit in which blood pressure is elevated. Multiple factors may influence this decision. For example, it has been found that optimal blood pressure control often requires three or more medications (8), leading to increas...

show abstract

“…The Appropriate Blood Pressure Control in Diabetes (ABCD) trial has provided valuable evidence for the excellent efficacy of nisoldipine, a calcium channel blocker, as a first-line antihypertensive agent in preventing or delaying the progression of diabetic nephropathy, retinopathy, neuropathy and cardiovascular disease with Type II (non-insulin-dependent) diabetes mellitus [8]. This clinical trial stresses the importance of intensive blood pressure control for reducing the risk of cardiovascular events in hypertensive patients with Type II diabetes.…”

mentioning

confidence: 99%

“…Indeed, calcium channel blockers such as amlodipine have been shown to improve cardiac remodelling in spontaneously hypertensive rats [26], myocardial infarcted rats [27] and idiopathic dilated cardiomyopathic hamsters [28]. In the light of the clinical studies showing the efficacy of calcium channel blocker therapy in preventing cardiovascular disease in patients with diabetes [8,9], the favourable actions of treatment with calcium channel blockers on cardiovascular functions in diabetes might be partly based on their beneficial effects on the remodelling process associated with growth factors causing cardiac angiogenesis and fibrosis. However, it is not clear what role is played by angiogenic growth factors in cardiac remodelling during diabetes.…”

mentioning

confidence: 99%

Long-acting calcium channel blocker benidipine suppresses expression of angiogenic growth factors and prevents cardiac remodelling in a Type II diabetic rat model

et al. 2002

View full text Add to dashboard Cite

Cardiovascular deterioration is one of the complicating features of diabetes mellitus. Patients suffering from diabetes mellitus are prone to disorders of the cardiovascular system, including microangiopathies and macroangiopathies, atherosclerosis, congestive heart failure and hypertension [1]. Mortality from cardiovascular disease is almost three times higher in diabetic patients than in the general population [2]. Several causes have been put forward to explain the development of cardiovascular dysfunction during diabetes. They include microangiopathic changes [3], abnormalities in vascular sensitivity and reactivity to Diabetologia (2002) Results. OLETF rats showed an increased coronary capillary density, a reduced venular capillary proportion, an increased cardiac collagen content and prominent cardiac perivascular fibrosis. In OLETF rat hearts, significant increases in vascular expressions for VEGF, bFGF and TGF-b 1 were found. Furthermore, the apoptosis signalling pathways, involving eNOS and apoptotic markers, were markedly altered, and coronary endothelial cell apoptosis was lower. These alterations with the exception of eNOS expression were significantly blocked by benidipine treatment. Conclusion/interpretation. The suppressive effect of benidipine on overproduction of angiogenic growth factors could prevent cardiac angiogenesis and fibrosis, resulting in an improvement of cardiac remodelling in diabetes. As VEGF and bFGF potently block endothelial cell apoptosis execution, physiological apoptosis revived by benidipine treatment could also contribute to coronary vessel regression. [Diabetologia (2002) 45: 402±415]

show abstract

Appropriate Blood Pressure Control in NIDDM (ABCD) Trial

Cited by 85 publications

References 46 publications

Predictors of Health Care Costs in Adults With Diabetes

Predictors of Health Care Costs in Adults With Diabetes

Action or Inaction? Decision Making in Patients With Diabetes and Elevated Blood Pressure in Primary Care

Long-acting calcium channel blocker benidipine suppresses expression of angiogenic growth factors and prevents cardiac remodelling in a Type II diabetic rat model

Contact Info

Product

Resources

About