A Statewide Primary Care Approach to Cardiovascular Risk Factor Control in High‐Risk Diabetic and Nondiabetic Patients With Hypertension

Abstract

Patients with multiple cardiovascular risk factors benefit from having them all controlled, but this rarely occurs. Fifty-seven primary care providers were enrolled in a program to monitor cardiovascular risk factor control. Data were obtained on 7315 hypertensives. This analysis focuses on 3460 high-risk hypertensives including 2199 with diabetes and 1261 with clinical cardiovascular disease. Blood pressures were <140/90 mm Hg and <130/80 mm Hg in only 44.3% and 20.4% of diabetics and 49.6% and 26.6% nondiabetics, respectively, despite the use of an average of 2.7+/-1.8 antihypertensive medications. Among high-risk dyslipidemic hypertensives, the low-density lipoprotein cholesterol level was <100 mg/dL in only 34% of diabetic and 33% of nondiabetic patients. Among 1696 diabetic hypertensives, the most recent glycosylated hemoglobin value averaged 7.5%, with 46.6% less than 7%. Among 805 diabetic, dyslipidemic hypertensives, all three risk factors were controlled to goal in only 6.6% with higher rates in whites than in African Americans (14.8% vs. 1.6%, p<0.001). An angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, or both were prescribed in 89.9% of diabetic and 70.8% of nondiabetic patients, p<0.05. Primary care providers use evidence-based combination therapy in high-risk hypertensive patients with and without diabetes. These findings confirm the low rates of multiple risk factor control and highlight challenges of reaching evidence-based goals in primary care.

Treatment and control of hypertension in Turkish population: a survey on high blood pressure in primary care (the TURKSAHA study)

“…15,18 Similar to previous studies, our study also demonstrated that the blood pressure control was worse among diabetics and those with a high BMI. 16,17,21 In the multivariate analysis, the presence of concomitant CVD showed a negative association with high blood pressure, a finding being consistent with literature. 16 As with many countries, there are differences between geographic regions for the developmental level in Turkey, and the blood pressure control rate may vary between the geographic regions of Turkey and according to the status of socioeconomic level.…”

Treating hypertension in type II diabetic patients with device-guided breathing: a randomized controlled trial

“…The patients reported a relatively healthy lifestyle, including physical exercises (71%), diet (75%), not smoking (89%) and not consuming alcohol (85%). In total, 30% of the study population were born in Israel, 32% were born in Europe or America, 20% in Asia and 18% in North Africa, The mean number of years of education was 13 (range [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The mean duration of diabetes was 6.6 years (range 1-23).…”

“…11,12 However, data show that only 44.3% achieve a BP o140/90 mm Hg and only 20.4% reach the recommended target of o130/80 mm Hg. 13 Compliance with drug therapies is compromised by cost, high frequency of dosing and side effects. 14 Use of some antihypertensive medication may even precipitate the clinical onset of diabetes, 15 making the use of non-pharmacological treatment even more attractive.…”

Medication Adherence in a Sample of Elderly Suffering from Hypertension: Evaluating the Influence of Illness Perceptions, Treatment Beliefs, and Illness Burden

“…6,7 However, studies evaluating data from those with hypertension-obtained from various sources such as national survey data, epidemiologic studies, ambulatory care practices, and high-risk patients-report a varying rate of hypertension control ranging from 29% to 50%. 4,[8][9][10][11][12][13][14][15][16][17] Medication nonadherence is cited as the primary cause for lack of hypertension control. 5,18 Medication nonadherence is defined as the failure to adhere to medication instructions, either willfully or inadvertently.…”