Abstract 137: Comparing Blood Pressure Control in Diabetic Versis Nondiabetic Veterans Following Percutaneous Coronary Intervention

Abstract

Background: As per the US Joint National Committee VII (JNC-7) recommendations, patients with known underlying coronary artery disease and diabetes should have goal blood pressures (BP) of systolic (SBP) <130 and diastolic (DBP) <80 to decrease morbidity and mortality associated with cardiovascular disease. In addition to lifestyle modification, these goals can be attained by use of multiple classes of drugs including beta-blockers (BB), angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARB), calcium channel blockers (CCB), diuretics and nitrates. Methods: We conducted a retrospective cohort study focusing on the attainment of the JNC-7 guidelines, comparing outcomes between 355 diabetic to 580 non-diabetic patients undergoing PCI between September 2004 and January 2011 at the Jesse Brown Veterans Affairs Hospital in Chicago, IL. BP measurements and antihypertensive medications pre and post PCI at 6-month follow-up were documented. Results: Among the diabetic population, the mean SBP decreased from 136 to 131 mmHg (p = 0.0007) and mean DBP decreased from 73 to 70 mmHg (p = 0.0005). In the non-diabetics, the mean SBP decreased from 133 to 127 mmHg (p < 0.0001) and the mean DBP decreased from 73 to 70 mmHg (p < 0.0001). With regards to JNC-7 guidelines, the percent of diabetics at SBP goal increased from 39% to 49% (p = 0.0053) and percent at DBP goal increased from 73% to 82% (p = 0.0098). In non-diabetics, percent at goal for SBP increased from 45% to 57% (p < 0.0001) and percent at DBP goal increased from 68% to 76% (p = 0.0009). Among diabetics, there was a statistically significant (p <0.0001) increase in use of BB from 79% to 92%. In non-diabetics, there was a statistically significant (p <0.0001) increase in use of BB from 66% to 87% and ACE-I/ARB from 51% to 70%. Conclusions: In both groups undergoing PCI, SBP and DBP improved with more patients achieving JNC-7 targets. Among diabetics, there was a significant increase in utilization of BB. Among non-diabetics, there was a significant increase in utilization of BB and ACE-I/ARB.