Blood Pressure Control in Hypertensive Patients with Type 2 Diabetes Mellitus

Abstract

Introduction and objective. Blood pressure (BP) goals and glycemic targets are only reached in 40% and 50% of patients, respectively. The objective of this observational retrospective cohort study was analyzing BP control with antihypertensive therapy in patients with diabetes mellitus (DM) and arterial hypertension (HTN) in clinical practice. Methods. 156 hospitalized hypertensive patients with type 2 DM were divided into 2 groups (G): G1 - uncomplicated and G2 - complicated DM, with micro- and macrovascular involvement, followed retrospectively for 2 years. BP control with antihypertensives was analyzed with respect to DM control, complications, hospital readmissions for cardiovascular disease and all-cause mortality. Results. Of the 156 patients, 71 (45.6%) males, mean age 66.7 ± 9.8 years, 94 (60.3%) were included in G2. Ninety-one patients (58.3%) were rehospitalized, G2 patients having a significantly higher risk of readmission (p=0.006). BP was controlled in 57.7% patients at first, and in 59.3% patients on the last hospitalization, while DM was initially controlled in 49.3% patients, and in 54.9% on the last readmission. The number of antihypertensive drug classes was significantly higher in G2 (3.5 vs 3.1, p=0.03). Fifteen (9.6%) patients were initially on fixed-dose combinations (FDC). All-cause mortality after 2 years was 12.2%, strongly associated with DM complications (p=0.005), with a protective effect from controlled DM (p=0.045). Conclusion. More than forty percent of the patients had uncontrolled long term HTN with frequent re-hospitalizations and increased mortality. Better BP control could be achieved by changing therapy, notably by FDC, promoting patient adherence.