Clinical Inertia in the Treatment of Hypertension for Individuals With Diabetes

OBJECTIVE The 2023 American Diabetes Association (ADA) “Standards of Care in Diabetes” updated the recommended blood pressure (BP) goal to <130/80 mmHg for all people with diabetes, regardless of age, if it can be safely attained. We assessed whether this guideline change led to a change in BP control. RESEARCH DESIGN AND METHODS This retrospective, interrupted time series study from a large integrated health care delivery system assessed BP control from 1 January through 30 November 2022 (pre-guideline) compared with 1 December 2022 through 31 December 2023 (post-guideline). We assessed adults (aged ≥18 years) with comorbid diabetes and hypertension for the percentage of patients with a median BP of <130/80 mmHg, 130/80 to 139/89 mmHg, and ≥140/90 mmHg. Secondary outcomes examined prescribing rate trends of antihypertensive medication classes, sodium–glucose cotransporter 2 inhibitors (SGLT2is), glucagon-like peptide 1 (GLP-1) agonists, and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) agonists. RESULTS We examined 24,211 median monthly BP measures before guideline publication and 28,889 after guideline publication. There was no significant difference in trend for meeting BP <130/80 mmHg pre- to post-guideline change after adjusting for differences in patient characteristics and seasonality (odds ratio 1.05, 95% CI 0.98–1.13, P = 0.16). Prescribing rates of SGLT-2i and GLP-1 or GLP-1/GIP medications increased both pre- and post-guideline release. There was a negative change in the trend of total number of antihypertensive classes prescribed pre- to post-guideline change (estimated difference −0.04, 95% CI −0.05 to 0.02, P < 0.001). CONCLUSIONS Updates to the ADA guidelines did not alter BP control and antihypertensive prescribing, suggesting therapeutic inertia.