Blood Pressure Control Has Improved in People with and without Type 2 Diabetes but Remains Suboptimal: A Longitudinal Study Based on the German DIAB-CORE Consortium

Abstract

BackgroundHypertension 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.MethodsData 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.ResultsMean 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.ConclusionBlood 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.

Clinical outcomes after cardiac rehabilitation in elderly patients with and without diabetes mellitus: The EU-CaRE multicenter cohort study

“…The reason for the conflicting results may be the older mean age of the patients of our compared to the German registry study. The association of pulse pressure and arterial stiffness [40] may imply that our diabetic patients had higher arterial stiffness than the non-diabetic patients [40], which has also been suggested in previous studies [41][42][43]. The reason for this may be early ageing of the vessel properties due to the latent chronic inflammation in patients with DM [44,45].…”

<b>Factors related to blood pressure control in a prospective cohort of hypertensive outpatients

“…Lower chances of poor BP control in hypertensive patients with diabetes were detected when compared to non-diabetic ones. In a German longitudinal study (DIAB-CORE Consortium) hypertension control was achieved only in about half the number of people with T2DM (Rückert et al, 2015). Possible explanations for current findings may include better engagement of TD2M patients with regard to the clinical control of comorbidities.…”

Changes in Hypertension Prevalence, Awareness, Treatment, and Control in High-, Middle-, and Low-Income Countries: An Update

“…In Germany, a study by Rückert et al [12] found that hypertension awareness and control considerably improved in the entire German population; it nevertheless remained insufficient; hypertension control was achieved in about 50 % of patients with Type-2 diabetes and in about 60 % of individuals without Type-2 diabetes.…”