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Assessment and management of hypertension in patients with type 2 diabetes
1Danielle Alberti Memorial Centre for Diabetes Complications, Baker Medical Research Institute, Melbourne, Victoria, Australia.
Insights
Hypertension management in type 2 diabetes is suboptimal, especially for high-risk patients. While blood pressure control is achievable, further efforts are needed to improve treatment rates and outcomes in Australian primary care.
Area of Science:
- Cardiology
- Endocrinology
- Nephrology
Background:
- Hypertension is a significant risk factor for adverse outcomes in type 2 diabetes.
- Suboptimal blood pressure (BP) management persists, particularly in high-risk individuals.
- This study assessed hypertension prevalence and management in Australian primary care for type 2 diabetes patients.
Purpose of the Study:
- To estimate the frequency of hypertension in type 2 diabetes patients.
- To evaluate antihypertensive management strategies in Australian primary care.
- To compare BP control between two distinct patient cohorts.
Main Methods:
- Compared BP levels and antihypertensive strategies in DEMAND (2003) and NEFRON (2005) studies.
- Examined systolic BP and antihypertensive therapy use in patients with and without chronic kidney disease.
- Analyzed data from 1831 (DEMAND) and 3893 (NEFRON) type 2 diabetes patients.
Main Results:
- Over 80% of patients in both studies were hypertensive.
- Systolic BP targets (< or =130 mmHg) were met by approximately half of treated patients.
- Antihypertensive therapy use increased from 70.4% to 79.5% between 2003 and 2005, but remained underutilized in high-risk groups.
Conclusions:
- Blood pressure control is achievable in Australian general practice for type 2 diabetes patients.
- Over half of patients achieved target systolic BP (< or =130 mmHg).
- Further BP reduction is necessary, especially for patients at high risk of adverse outcomes.
Background:
Hypertension is a major risk factor for adverse outcomes in type 2 diabetes and an important target for intervention. Despite this, the management of blood pressure (BP) remains suboptimal, particularly in patients at increased risk for cardiovascular and chronic kidney disease. The aim of this study was to estimate the frequency of hypertension and its management in consecutive clinic-based samples of patients with type 2 diabetes in Australian primary care.
Methods:
BP levels and antihypertensive management strategies were compared in patients with type 2 diabetes recruited as part of the Developing Education on Microalbuminuria for Awareness of reNal and cardiovascular risk in Diabetes (DEMAND) study in 2003 (n = 1831) and the National Evaluation of the Frequency of Renal impairment cO-existing with Non-insulin-dependent diabetes (NEFRON) study in 2005 (n = 3893). Systolic BP levels and the use of antihypertensive therapies were examined in patients with and without chronic kidney disease.
Results:
The patient characteristics in both studies were similar in that more than 80% of patients in both studies were hypertensive. Systolic BP targets of < or =130 mmHg were achieved in approximately half of all treated patients in both studies. However, the use of antihypertensive therapy either alone or in combination increased from 70.4% in DEMAND to 79.5% in NEFRON 2 years later (P < 0.001). Despite this, antihypertensive therapy continued to be underutilized in high-risk groups, including in those with established chronic kidney disease.
Conclusion:
The DEMAND and NEFRON studies both show that BP control is achievable in Australian general practice, with more than half of all patients seeing their general practitioners achieving a target systolic BP < or =130 mmHg. However, more needs to be done to further reduce BP levels, particularly in patients at high risk of adverse outcomes.
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