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Item #5 

Antihypertensive Therapy Found to be Suboptimal in Patients With Diabetes

Hypertension is more likely to be inadequately controlled in diabetic patients than in nondiabetics.

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

Dr. Berlowitz and his team analyzed medical records from 274 hypertensive patients with diabetes and 526 similar patients without diabetes. All of the patients were male military veterans who had received regular medical care in the northeastern US between 1990 and 1995.

Overall, 73% of the diabetics had blood pressures that were at least 140/90 mm Hg, the investigators report in the February issue of Diabetes Care. In contrast, the proportion of nondiabetics with such poor control was significantly lower at 66% (p = 0.04).

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

One reason for the less aggressive treatment, the researchers speculate, is that physicians may be unfamiliar with current guidelines that call for a target blood pressure of below 130/85 in diabetics.  Diabetes Care 2003;26:355-359,534-535

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