Abstract
BackgroundThe prevalence of type 2 diabetes is rising, and most of these patients also have hypertension, substantially increasing the risk of cardiovascular morbidity and mortality. The majority of these patients do not reach target blood pressure levels for a wide variety of reasons. When a literature review provided no clear focus for action when patients are not at target, we initiated a study to identify characteristics of patients and providers associated with achieving target BP levels in community-based practice.MethodsWe conducted a practice- based, cross-sectional observational and mailed survey study. The setting was the practices of 27 family physicians and nurse practitioners in 3 eastern provinces in Canada. The participants were all patients with type 2 diabetes who could understand English, were able to give consent, and would be available for follow-up for more than one year. Data were collected from each patient's medical record and from each patient and physician/nurse practitioner by mailed survey. Our main outcome measures were overall blood pressure at target (< 130/80), systolic blood pressure at target, and diastolic blood pressure at target. Analysis included initial descriptive statistics, logistic regression models, and multivariate regression using hierarchical nonlinear modeling (HNLM).ResultsFifty-four percent were at target for both systolic and diastolic pressures. Sixty-two percent were at systolic target, and 79% were at diastolic target. Patients who reported eating food low in salt had higher odds of reaching target blood pressure. Similarly, patients reporting low adherence to their medication regimen had lower odds of reaching target blood pressure.ConclusionsWhen primary care health professionals are dealing with blood pressures above target in a patient with type 2 diabetes, they should pay particular attention to two factors. They should inquire about dietary salt intake, strongly emphasize the importance of reduction, and refer for detailed counseling if necessary. Similarly, they should inquire about adherence to the medication regimen, and employ a variety of patient-oriented strategies to improve adherence.
Highlights
The prevalence of type 2 diabetes is rising, and most of these patients have hypertension, substantially increasing the risk of cardiovascular morbidity and mortality
A review of the literature revealed a wide array of patient, physician, and health system factors contributing to the success or failure in reaching target blood pressure (BP) goals
Patients were included if they had their most recent BP measurement taken with a BpTRUTM within the past six months in order to relate that pressure with the results of the patient survey
Summary
The prevalence of type 2 diabetes is rising, and most of these patients have hypertension, substantially increasing the risk of cardiovascular morbidity and mortality The majority of these patients do not reach target blood pressure levels for a wide variety of reasons. A review of the literature revealed a wide array of patient, physician, and health system factors contributing to the success or failure in reaching target BP goals Many, such as patient age [4,11,12,13,14,15,16,17] and sex [4,11,13,16,18,19,20] and physician age [12] and sex [12,14] are not modifiable. Our baseline data had shown that patients were already taking an average of 2.5 antihypertensive medications [2], close to the 2.9 found necessary to reach a target of less than 130/80 in an American study [18]
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