Characteristics and blood pressure management in patients with and without diabetes in primary care in rural Victoria

Abstract

Aims/hypothesis This study tested whether diabetic hypertensive patients receive more intensive BP management than hypertensive patients without diabetes. Methods A 12 month retrospective review of BP management was undertaken among 2460 hypertensive patients (335 with diabetes), aged 40–79 years from randomly selected general practices in rural Australia. Results Prevalent diagnosed cardiovascular disease (CVD) was commoner among diabetic than non-diabetic patients (27.2% vs. 16.0%, OR 1.82 (1.39–2.39)). The proportion with a BP < 130/80 mm Hg was low (22.9% vs. 18.6%, p = .069, respectively). BP was monitored more closely among diabetic patients (e.g. quarterly BP measurements in 18.2% vs. 10.5% respectively, p < .001), was treated with more anti-hypertensive agents (1.5 ± 1.0 vs. 1.0 ± 1.0, p < 001) and was more likely to be associated with other CVD medications. Achievement of non-diabetic BP targets was associated with living in the regional centre (vs. smaller rural town: 1.21 (1.02–1.43)) and CVD (1.54 (1.21–1.95)), but not the presence of diabetes (0.94 (0.73–1.19)). Conclusions In this population, hypertension is more aggressively monitored and treated among diabetic than non-diabetic patients, but largely due to their CVD and not to the level recommended in guidelines. Commencing anti-hypertensive treatment earlier (e.g. at diagnosis) and recommending more agents (e.g. in combination) may be needed to improve BP control among diabetic patients on a population basis.