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Hypertension management in outpatient visits by diabetic patients
Rajender R Aparasu1, Anuradha Aparasu
1Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Texas Medical Center, 1441 Moursund Street, Houston, TX 77030, USA. rraparasu@uh.edu
Insights
Hypertension management in diabetic patients often involves behavioral therapy and medications, but optimal blood pressure control is achieved in only one-third of visits. Increased use of ACE inhibitors or ARBs is needed for better outcomes in hypertensive diabetic patients.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Hypertension is a frequent comorbidity in patients with diabetes mellitus.
- Limited national data exist on hypertension management, particularly the use of ACE inhibitors (angiotensin-converting enzyme inhibitors) or ARBs (angiotensin receptor blockers), in this population.
- ACE inhibitors and ARBs are guideline-recommended first-line treatments for hypertensive diabetic patients.
Purpose of the Study:
- To examine hypertension management strategies, including behavioral interventions and pharmacotherapy, in a nationally representative sample of diabetic patients.
- To assess the utilization of ACE inhibitors and ARBs in hypertensive diabetic patients.
Main Methods:
- Utilized data from the 2003-2004 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey.
- Employed descriptive analysis to evaluate behavioral therapy and pharmacotherapy use.
- Conducted multivariate analysis to identify factors associated with ACE inhibitor and ARB prescribing variations.
Main Results:
- An estimated 34 million outpatient visits by hypertensive diabetic patients occurred in 2003-2004.
- 66% of visits had uncontrolled blood pressure (> 130/80 mmHg).
- ACE inhibitors and ARBs were prescribed in 36% and 19% of visits, respectively. Patients with uncontrolled blood pressure were more likely to receive these agents, while racial disparities were observed, with American Indians less likely to receive them.
Conclusions:
- While behavioral therapy and pharmacotherapy are common, only one-third of hypertensive diabetic patients achieved optimal blood pressure control.
- Targeted interventions are necessary to enhance the prescription of ACE inhibitors or ARBs.
- Improving hypertension management in diabetic patients requires increased utilization of recommended pharmacotherapies.
Background:
Hypertension is a common comorbidity among patients with diabetes. Few national studies have examined hypertension management in diabetic patients and even fewer studies have examined prescribing of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), the recommended first line of treatment in hypertensive diabetic patients.
Objective:
This study examined hypertension management, including behavioral therapy and pharmacotherapy, in a nationally representative sample of outpatient visits by diabetic patients.
Methods:
The 2003--2004 National Ambulatory Medical Care Survey and the outpatient department portion of the 2003--2004 National Hospital Ambulatory Medical Care Survey were used to examine hypertension management in patients with diabetes and hypertension. Descriptive analysis was used to evaluate utilization of behavioral therapy and pharmacotherapy in hypertensive diabetic patients. Multivariate analysis was used to examine prescribing variation in the use of ACE inhibitors and ARBs in hypertensive diabetic patients.
Results:
An estimated 34 million outpatient visits were made by hypertensive diabetic patients in 2003--2004. Blood pressure > 130/80 mmHg was found in 66% of the outpatient visits by hypertensive diabetic patients. Nearly 57% of these visits involved educational and counseling services, with 53% receiving diet and nutrition services. In 71% of these visits antihypertensive agents were used, with 49% involving 2 or more antihypertensive agents. ACE inhibitors and ARBs were prescribed in 36% and 19% of the visits, respectively. Multivariate analysis found that patients with blood pressure > 130/80 mmHg were more likely to receive ACE inhibitors or ARBs and patients of other races, especially American Indians, were less likely to receive ACE inhibitors or ARBs.
Conclusions:
The study found that although behavioral therapy and pharmacotherapy are often used for hypertension management in diabetic patients, optimal blood pressure was observed in only one third of the visits. Targeted efforts are needed to increase the use of ACE inhibitors or ARBs to improve hypertension management in diabetic patients.
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