Key result
Patients with diabetes were significantly less likely to reach their recommended blood pressure target after 6 months compared to those without diabetes (26% vs 64%, P<0.001), largely due to clinical inertia.
Observational (n=2,030)
Yes
Absolute Event Rate: 25.9% vs 63.6%
p-value: p=<0.001
Poor blood pressure control in hypertensive patients, particularly those with coexisting diabetes, is significantly driven by clinical inertia and a failure to uptitrate antihypertensive therapy.
Clinical inertia may underlie poor BP control in diabetic hypertension; leaves open whether uptitration protocols improve target attainment.
Despite improvements in blood pressure (BP) control, a substantial percentage of patients do not achieve target. The relative importance of determinants of poor BP control is unclear. Therefore, the authors conducted a post hoc exploratory analysis to assess determinants of BP control. Data were collected in 45 general practices, which enrolled patients with uncontrolled hypertension. Antihypertensive medication changes throughout the 6-month follow-up period were documented. Baseline and 6-month BPs were recorded. Of the 2030 patients analyzed, 320 had diabetes. Overall, 42% of patients did not achieve BP control. In multivariate analysis, failure to intensify therapy was identified as a significant independent predictor of lesser BP reduction. Of patients unable to reach target after 6 months, only 25% were prescribed ≥ 3 drugs. Patients with diabetes were significantly less likely to reach target than those without (26% vs 64%, P<.001). Antihypertensive therapy prescribed to patients with diabetes was only marginally more intensive than to those without. In patients with hypertension, whether with or without coexisting diabetes, poor BP control appears to be at least partially due to failure to uptitrate antihypertensive therapy. Clinical inertia is likely an important barrier to BP control.
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Nelson et al. (2010) conducted an observational in Uncontrolled hypertension (n=2,030). Diabetes mellitus vs. No diabetes was evaluated on Proportion of patients achieving recommended blood pressure target at 6-month follow-up (p=<0.001). Patients with diabetes were significantly less likely to reach their recommended blood pressure target after 6 months compared to those without diabetes (26% vs 64%, P<0.001), largely due to clinical inertia.
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