Hypertension Treatment and Control in Canadians With Diabetes

OBJECTIVES: In this study, we investigated hypertension control (<130/80 mmHg) among individuals with diabetes, use of first-line antihypertensive medications, and physician responses to uncontrolled blood pressure (BP) measurements (i.e. repeat measurements and medication intensification). METHODS: We performed a descriptive retrospective cohort study of adults with prevalent diabetes and hypertension followed at Ontario primary care practices, from their first BP measurement from 2013 to 2017, using the IQVIA (IQVIA Solutions Canada, Kirkland, Québec, Canada) data set. We characterized baseline BP control and antihypertensive therapy and followed these individuals over 24 months. We followed a nested cohort of individuals with uncontrolled BP readings (≥130/80 mmHg) to ascertain the frequency of guideline-concordant care, consisting of repeat BP assessment and drug intensification (dose increase, additional drug class prescription) within 6 weeks. RESULTS: Of the 10,814 adults included in the study, 7,437 (69%) had a BP≥130/80 mmHg (46% with BP≥140/90 mmHg). Baseline mean BP was 139.4/84.4 mmHg and appeared similar at 24 months. At baseline, most individuals were receiving monotherapy (60%), with 90% prescribed renin-angiotensin-aldosterone system inhibitors. Only 34% of individuals were prescribed dihydropyridine calcium channel blockers and 24% were prescribed thiazide/thiazide-like diuretics. Physicians infrequently arranged timely (within 6 weeks) repeat BP checks (50%), dose increases (18%), and medication additions (33%) after uncontrolled BP readings. CONCLUSIONS: The large majority of people with diabetes and hypertension had uncontrolled BP that persisted over 2 years. Therapeutic inertia, lack of follow-up, and underprescribing of dual and triple combination therapy contributed to persistently high BP measurements, demonstrating the need for improvements.