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Hypertension control after an initial cardiac event among Medicare patients with diabetes mellitus: A

Ashish Chaddha1, Maureen A Smith2,3,4, Mari Palta3,5

  • 1Division of Cardiology, Department of Medicine, William Beaumont Hospital, Royal Oak, MI, USA.

Journal of Clinical Hypertension (Greenwich, Conn.)
|April 24, 2018
PubMed

Insights

Achieving hypertension control in diabetic patients post-cardiac event is crucial. Beta-blockers and specialty visits improved control, while diuretics aided older adults, highlighting the need for multidisciplinary care.

Area of Science:

  • Cardiology
  • Endocrinology
  • Geriatrics
  • Health Services Research

Background:

  • Diabetes mellitus and cardiovascular disease (CVD) significantly increase mortality and recurrent cardiovascular events.
  • Effective hypertension control is vital for secondary CVD prevention in high-risk patients.

Purpose of the Study:

  • To determine hypertension control rates and predictors in Medicare patients with diabetes and uncontrolled hypertension after a cardiac event hospitalization.
  • To identify factors influencing successful blood pressure management for secondary CVD prevention.

Main Methods:

  • Retrospective analysis of linked electronic health record and Medicare data.
  • Cox proportional hazard models used to assess predictors of hypertension control within one year post-discharge.
  • Inclusion of sociodemographics, medications, healthcare utilization, and comorbidities in the analysis.

Main Results:

  • Medicare patients with diabetes were more likely to achieve hypertension control when prescribed beta-blockers at discharge.
  • A history of more specialty visits was associated with improved hypertension control.
  • Diuretic use was linked to better hypertension control in adults aged 80 and older.

Conclusions:

  • Guideline-directed, multidisciplinary care is essential for managing hypertension in complex, high-risk diabetic patients with CVD.
  • Specific medication classes (beta-blockers, diuretics) and healthcare utilization patterns (specialty visits) are key predictors of success.
  • Tailored approaches considering age and comorbidities are necessary for optimal patient outcomes.

Keywords:
clinical management of high blood pressure (HBP)coronary diseasediabeteshypertension in the elderly

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