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Action or inaction? Decision making in patients with diabetes and elevated blood pressure in primary care

Paul C Hicks1, John M Westfall, Rebecca F Van Vorst

  • 1Salud Family Health Center, 1115 Second St., Fort Lupton, CO 80621, USA. phicks@saludclinic.org

Diabetes Care
|November 30, 2006
PubMed

Insights

In primary care, many patients with diabetes exceed blood pressure goals. Clinicians consider multiple factors, not just blood pressure levels, when deciding on hypertension treatment.

Area of Science:

  • Cardiology
  • Endocrinology
  • Primary Care Medicine

Background:

  • Hypertension is a major risk factor for micro- and macrovascular complications in patients with diabetes.
  • The recommended blood pressure goal for individuals with diabetes is less than 130/80 mmHg.
  • Many patients with diabetes in primary care settings do not meet their blood pressure targets.

Purpose of the Study:

  • To investigate the clinical decision-making process of primary care providers when managing elevated blood pressure in patients with type 2 diabetes.
  • To identify factors influencing treatment decisions for hypertension in diabetic patients.

Main Methods:

  • A survey-based study involving 26 primary care practices across two research networks in Colorado.
  • Data collected from 778 encounters with adult patients with type 2 diabetes, including blood pressure readings, actions taken, and reasons for inaction.
  • Bivariate and multivariate analyses were used to determine predictors of provider action.

Main Results:

  • The average blood pressure among surveyed patients was 130/74 mmHg, with 62% exceeding the recommended goal.
  • Action to lower blood pressure was taken in only 34.9% of cases where goals were exceeded.
  • Key predictors for action included higher blood pressure levels, the total number of medications a patient was taking, and whether the patient was already on blood pressure medication.

Conclusions:

  • No evidence of substandard care patterns was observed among primary care physicians.
  • Providers weigh various clinical factors, such as the degree of blood pressure elevation, polypharmacy, medication side effects, and cost, in their treatment decisions.
  • Lack of knowledge does not appear to be a primary driver for inaction in managing hypertension in this patient population.
Abstract

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