Hypertension Treatment and Control in Canadians With Diabetes

Area of Science:

• Cardiology
• Endocrinology
• Primary Care Medicine

Background:

• Hypertension control is crucial for individuals with diabetes to prevent complications.
• Current guidelines recommend strict blood pressure (BP) targets (<130/80 mmHg) for diabetic patients.
• Therapeutic inertia and suboptimal medication management contribute to uncontrolled BP in this population.

Purpose of the Study:

• To investigate hypertension control in individuals with diabetes.
• To examine the use of first-line antihypertensive medications.
• To assess physician responses to uncontrolled BP readings, including repeat measurements and medication intensification.

Main Methods:

• A descriptive retrospective cohort study was conducted using IQVIA data from Ontario primary care practices (2013-2017).
• Adults with prevalent diabetes and hypertension were followed for 24 months.
• A nested cohort analyzed guideline-concordant care for uncontrolled BP (≥130/80 mmHg) within 6 weeks.

Main Results:

• 69% of 10,814 adults had uncontrolled BP (≥130/80 mmHg); 46% had BP ≥140/90 mmHg.
• Mean BP remained high at baseline (139.4/84.4 mmHg) and 24 months.
• Physicians infrequently performed timely BP checks (50%) or intensified treatment (18% dose increase, 33% new medication) within 6 weeks for uncontrolled readings.

Conclusions:

• A significant majority of patients with diabetes and hypertension experience persistent uncontrolled BP.
• Therapeutic inertia, inadequate follow-up, and underutilization of combination therapy contribute to poor BP control.
• Improvements in hypertension management strategies are necessary for this high-risk population.