Evaluating the treatment of hypertension in diabetes mellitus: a need for better control?

Sequeira, Reginald P.; Khaja, Khalid A. J. Al; Damanhori, Awatif H. H.

doi:10.1111/j.1365-2753.2003.00404.x

Cited by 15 publications

(9 citation statements)

References 51 publications

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“…Finally, it is interesting to note that the extent of BP control achieved in groups treated with mono-therapy or combination therapy did not differ significantly. Similar findings were obtained by Sequeira and co-workers and Westheim and co-workers 24,25. Potential explanation for the high proportions of poor BP control could be the lack of drug compliance among diabetic patients as a result of adverse events of the antihypertensive medications.…”

Section: Discussionsupporting

confidence: 84%

Evaluation of antihypertensive therapy in diabetic hypertensive patients: impact of ischemic heart disease

Sweileh

Sawalha

Zyoud

et al. 2009

Pharmacy Practice (Internet)

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*Macrovascular complications are common in diabetic hypertensive patients. Appropriate antihypertensive therapy and tight blood pressure control are believed to prevent or delay such complication. Objective: To evaluate utilization patterns of antihypertensive agents and blood pressure (BP) control among diabetic hypertensive patients with and without ischemic heart disease (IHD). Methods: Retrospective cohort study of all diabetic hypertensive patients attending Al-watani medical center from August 2006 until August 2007. Proportions of use of different antihypertensive drug classes were compared for all patients receiving 1, 2, 3, or 4 or more drugs, and separately among patients with and without IHD. Blood pressure control (equal or lower 130/80 mmHg) was compared for patients receiving no therapy, monotherapy, or combination therapy and separately among patients with and without IHD. Results: 255 patients were included in the study; their mean age was 64.4 (SD=11.4) years. Sixty one (23.9%) of the included patients was on target BP. Over 60% of the total patients were receiving angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin receptor blocker (ARB), followed by diuretics (40.8%), calcium channel blockers (25.1%) and beta-blockers (12.5%). The majority (> 55%) of patients were either on mono or no drug therapy. More than 55% of patients with controlled BP were using ACE-I. More than half (50.8%) of the patients with controlled BP were on combination therapy while 42.3% of patients with uncontrolled BP were on combination therapy (p=0.24). More patient in the IHD achieved target BP than those in non-IHD

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Section: Discussionsupporting

confidence: 84%

Evaluation of antihypertensive therapy in diabetic hypertensive patients: impact of ischemic heart disease

Sweileh

Sawalha

Zyoud

et al. 2009

Pharmacy Practice (Internet)

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“…This is lower than for other studies, which have reported values of 40% and 38.3% for office BP control at <140/90 mm Hg and 52% for <140/80 mm Hg . However, for studies that defined stricter control targets, the percentages were much lower at 23% (<135/85 mm Hg) and 11.4% and 9.8% (<130/85 mm Hg) . It should be noted that the ABPM values used as cutoffs for the definition of BP control in the present study were not specific for patients with T2DM.…”

Section: Discussioncontrasting

confidence: 90%

Blood pressure control and cardiovascular risk in hypertensive patients with type 2 diabetes: The German T2Target registry

Mengden

Ligges

Mielke

et al. 2017

J of Clinical Hypertension

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Blood pressure control in patients with type 2 diabetes and hypertension is poor. It is unclear how effectively general practitioners assess and treat such patients. T2Target included hypertensive patients with type 2 diabetes mellitus who had undergone ambulatory blood pressure monitoring within the past 3 months. Recordings were analyzed by the general practitioner and an independent center and the conclusions were compared. Nighttime hypertension was reported less frequently by the general practitioner in comparison with central assessment (43.9% vs 77.9%, P<.001), as were masked (4.0% vs 13.1%, P<.001) and isolated office (4.4% vs 8.8%, P<.001) hypertension. A total of 13.9% of patients were deemed to have controlled blood pressure (ambulatory blood pressure monitoring). For the 784 patients with uncontrolled blood pressure, 40.7% underwent no change to their antihypertensive treatment. Cardiovascular risk was underestimated, with 11.1% deemed to be at very high risk, in contrast to the 97.0% of patients by central assessment. In conclusion, blood pressure control in hypertensive patients with type 2 diabetes mellitus is poor and not accurately assessed by office‐based general practitioners, despite the use of ambulatory blood pressure monitoring.

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“…Nowadays, there is agreement that the simple access to medical followup through provision of medical insurance has not shown satisfactory BP control in hypertensive patients [2, 3, 5, 7]. Interestingly 8.5% of patients in our primary care-based cohort were managed exclusively with nonpharmacological measures, and 75% reached a target BP < 140/90 mmHg underscoring the importance of access to ancillary services as dietary and lifestyle changes counseling (e.g., increasing physical activity) along with the medical followup.…”

Section: Discussionmentioning

confidence: 99%

Overcoming Barriers in the Management of Hypertension: The Experience of the Cardiovascular Health Program in Chilean Primary Health Care Centers

Sandoval

Bravo²,

Koch³

et al. 2012

International Journal of Hypertension

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Objective. To assess the blood pressure control and cardiovascular risk factors (CVRFs) in a population of hypertensive patients with access to care under a government-financed program, the Cardiovascular Health Program (CHP). Design. A cross-sectional and multicenter study. Setting. 52 primary care centers, metropolitan area of Santiago, Chile. Participants. 1,194 patients were selected by a systematic random sampling from a universe of 316,654 hypertensive patients. Key Measurements. Demographic information, blood pressure (BP) measurements, and CVRF were extracted from medical records of patients followed for a 12-month period. Results. 59.7% of patients reached target BP <140/90 mmHg. More women were captured in the sampling (2.1 : 1), achieving better BP control than men. Diabetic patients (26.4%) had worse BP control than nondiabetics. Antihypertensive medications were used in 91.5%, with multidrug therapy more frequent in patients with higher BP and more difficult control. Conclusions. The success in improving the BP control to values <140/90 mmHg from 45.3% to 59.7% underscores the contribution of this program in the Chilean primary care cardiovascular preventive strategies. However, fewer hypertensive men than women were captured by this program, and it is of concern the underperforming of BP control observed in diabetics.

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Evaluating the treatment of hypertension in diabetes mellitus: a need for better control?

Cited by 15 publications

References 51 publications

Evaluation of antihypertensive therapy in diabetic hypertensive patients: impact of ischemic heart disease

Evaluation of antihypertensive therapy in diabetic hypertensive patients: impact of ischemic heart disease

Blood pressure control and cardiovascular risk in hypertensive patients with type 2 diabetes: The German T2Target registry

Overcoming Barriers in the Management of Hypertension: The Experience of the Cardiovascular Health Program in Chilean Primary Health Care Centers

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