PP.05.26

Abstract

Objective: Tight blood pressure control with a mean office blood pressure of 144/82 mmHg in patients with hypertension and type 2 diabetes achieves a clinically important reduction in hypertension related complications such as stroke (UKPDS). Further blood pressure reduction to an office blood pressure of 135/75 mmHg reduced cardiovascular mortality by 18% compared to placebo (140/75 mmHg) in the ADVANCE trial. The objective of the present registry study was to investigate the role of ambulatory-24-h-blood pressure measurement (ABPM) for the clinical management of hypertensive patients with type 2 diabetes in the general physician[Combining Acute Accent]s (GP) office. Design and method: 919 ABPM recordings of type 2 diabetic patients (age 64.4 + 12.3 years) with treated hypertension were obtained at 306 GPs using validated recorders. Hypertension management based on ABPM recordings of the 306 GPs was compared to a central, blinded and independent analysis of ABPM recordings in accordance with the recent ESH guidelines. Results: Mean office blood pressure was 151.7 ± 19.6/87.5 ± 11.5 mmHg. Mean ABPM daytime values were 141.3 ± 15.2/81.8 ± 10.2 mmHg and night-time values were 131.1 ± 18.3/72.6 ± 11.1 mmHg. The predominant form of hypertension based on ABPM was systolic/diastolic hypertension (58%) followed by isolated systolic hypertension (21%). Control rate of hypertension based on ABPM was estimated to be 64% by GPs. In contrast a control rate of 14% was calculated based on a central analysis according to ESH-ABPM guidelines. The GPs assessed the 10-year cardiovascular risk to be “very high” as to the definition of the ESH in 11% of their patients, while the estimated 10-year risk was “very high” in 892 patients (97%) based on the central, independent analysis. Despite 784 patients were deemed uncontrolled, antihypertensive therapy remained unchanged in 322 patients (41%). Conclusions: Blood pressure control was grossly overestimated in patients with hypertension and type-2 diabetes. This resulted in an underestimation of the total cardiovascular risk and a lack of efforts to control blood pressure more tightly. Whether a lack of therapeutic decision making of GPs was caused by inertia or a lack of knowledge of ABPM normal values remains to be determined.