Blood pressure control and ACE inhibitor/angiotensin receptor blocker usage

The aim of this audit was to determine the changes over a four‐year period in the numbers of type 2 patients with microalbuminuria (MA) and diabetic nephropathy (DN) treated with angiotensin converting enzyme inhibitor (ACE‐I) and/or angiotensin receptor blocker (ARB) therapy and who had achieved target blood pressure (BP) control. We undertook a retrospective electronic case note audit of 200 type 2 patients attending hospital diabetes clinics. Patients were divided into three groups: MA, DN and normoalbuminuric. Results were compared with a similar audit carried out four years previously. The three groups were well matched for numbers, age, sex and HbA 1c . The numbers achieving target BP had not improved in all three groups. There was no improvement in systolic BP but diastolic BP improved significantly in all groups— MA 74±12 to 69±11 (p = 0.03); DN 78±12 to 70±13 (p = 0.02); and normoalbuminuric 73±12 to 69±11 (p = 0.006). Only the normoalbuminuric group showed a significant increase in the numbers prescribed ≥ three antihypertensive drugs (14% to 28%, p = 0.008). Treatment with ACE‐I and/or ARB had improved overall in the MA group (53% to 92%, p<0.0001), and in the normoalbuminuric group (41% to 57%, p = 0.01). Usage of ARB therapy increased significantly in all groups— MA 3% to 23% (p = 0.01); DN 13% to 47% (p = 0.003); and normoalbuminuric 2% to 15% (p = 0.0003). We conclude that hypertension remains under‐treated, especially in the MA and DN groups despite an improvement in the usage of ACE‐I and ARB therapy. Widespread use of protocol‐driven, nurse‐led clinics may help to intensify management.