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Blood Pressure Control Has Improved in People with and without Type 2 Diabetes but Remains Suboptimal: A Longitudinal
Ina-Maria Rückert1, Jens Baumert1, Michaela Schunk2
1Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; German Center for Diabetes Research (DZD e.V.), Partner Neuherberg, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
Insights
Hypertension management in Type 2 Diabetes (T2D) has improved in Germany, with better awareness and treatment. However, blood pressure control remains a challenge for about half of individuals with T2D.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Hypertension is a significant comorbidity and risk factor for cardiovascular disease, particularly in individuals with Type 2 Diabetes (T2D).
- Previous studies indicate suboptimal blood pressure control in clinical practice.
- The DIAB-CARE study investigated improvements in hypertension care over the past decade within the German DIAB-CORE Consortium.
Purpose of the Study:
- To assess the changes in hypertension care and control among participants with and without Type 2 Diabetes (T2D) over a decade.
- To analyze trends in blood pressure, awareness, treatment, and control in relation to T2D status.
Main Methods:
- Pooled data from three German population-based studies (CARLA, KORA, SHIP) with baseline and follow-up examinations.
- Analysis stratified by T2D status, examining changes in hypertension awareness, treatment, and control.
- Linear mixed models used to assess factors influencing systolic blood pressure changes, including sex, age, study, and T2D status.
- Included 4,683 participants aged 45-74 years, with inverse probability weighting for 1,256 individuals lost to follow-up.
Main Results:
- Mean systolic blood pressure decreased across all groups, with a notable reduction in those with incident T2D.
- Pulse pressure was significantly higher in individuals with T2D compared to those without, with minimal change over time.
- Hypertension awareness, treatment, and control rates increased substantially in all subgroups.
- Approximately 50% of individuals with hypertension, especially those with prevalent T2D, had inadequately controlled blood pressure.
- Elderly individuals with T2D frequently exhibited both high blood pressure (≥140/90 mmHg) and elevated pulse pressure (≥60 mmHg).
- Blood pressure improved more in men than in women, though men still had higher mean systolic blood pressure at follow-up.
Conclusions:
- Hypertension management in Germany has shown positive developments over the past decade.
- While prevalence, awareness, and treatment of hypertension were higher in participants with T2D, control was achieved in only about half of these individuals.
- Significant room for improvement remains in achieving optimal hypertension control, particularly for individuals with Type 2 Diabetes.
Background:
Hypertension is a very common comorbidity and major risk factor for cardiovascular complications, especially in people with Type 2 Diabetes (T2D). Nevertheless, studies in the past have shown that blood pressure is often insufficiently controlled in medical practice. For the DIAB-CARE study, we used longitudinal data based on the German DIAB-CORE Consortium to assess whether health care regarding hypertension has improved during the last decade in our participants.
Methods:
Data of the three regional population-based studies CARLA (baseline 2002-2006 and follow-up 2007-2010), KORA (baseline 1999-2001 and follow-up 2006-2008) and SHIP (baseline 1997-2001 and follow-up 2002-2006) were pooled. Stratified by T2D status we analysed changes in frequencies, degrees of awareness, treatment and control. Linear mixed models were conducted to assess the influence of sex, age, study, and T2D status on changes of systolic blood pressure between the baseline and follow-up examinations (mean observation time 5.7 years). We included 4,683 participants aged 45 to 74 years with complete data and accounted for 1,256 participants who were lost to follow-up by inverse probability weighting.
Results:
Mean systolic blood pressure decreased in all groups from baseline to follow-up (e.g. - 8.5 mmHg in those with incident T2D). Pulse pressure (PP) was markedly higher in persons with T2D than in persons without T2D (64.14 mmHg in prevalent T2D compared to 52.87 mmHg in non-T2D at baseline) and did not change much between the two examinations. Awareness, treatment and control increased considerably in all subgroups however, the percentage of those with insufficiently controlled hypertension remained high (at about 50% of those with hypertension) especially in prevalent T2D. Particularly elderly people with T2D often had both, high blood pressure ≥140/90 mmHg and a PP of ≥60 mmHg. Blood pressure in men had improved more than in women at follow-up, however, men still had higher mean SBP than women at follow-up.
Conclusion:
Blood pressure management has developed positively during past years in Germany. While hypertension prevalence, awareness and treatment were substantially higher in participants with T2D than in those without T2D at follow-up, hypertension control was achieved only in about half the number of people in each T2D group leaving much room for further improvement.