Historical Gaps in Kidney and Cardiovascular Risk Assessment Among Patients With Diabetes and Hypertension: A Real-World Primary Care Study

OBJECTIVE: Individuals with both diabetes and hypertension are at high risk for micro- and macrovascular complications, underscoring the importance of regular monitoring of glycated hemoglobin (A1C), cholesterol, urine albumin-to-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR). METHODS: We analyzed laboratory tests from 4,456 adults from primary care practices with diabetes and hypertension, each with at least 2 blood pressure measurements between January 1, 2013, and December 31, 2017, and at least 1 test (A1C, UACR, eGFR, and low-density lipoprotein cholesterol [LDL-C]) within 2 years. Test completion rates and results were reported across 3 blood pressure categories: controlled (<130 mmHg/<80 mmHg), stage 1 hypertension (130-139 mmHg/80-89 mmHg), and stage 2 hypertension (≥140 mmHg/≥90 mmHg). RESULTS: ), and 54% had dyslipidemia (LDL-C ≥2.0 mmol/L). Those with stage 2 hypertension had higher rates of albuminuria, CKD, and dyslipidemia than those with controlled or stage 1 hypertension. CONCLUSIONS: Our study has 3 key findings. UACR testing was underutilized among patients with diabetes and hypertension. Consistent screening could identify individuals who would benefit from guideline-directed antiproteinuric therapies. Uncontrolled blood pressure was associated with higher rates of albuminuria and dyslipidemia. Achievement of LDL-C <2.0 mmol/L was suboptimal in over 50% of patients, necessitating improved cardiovascular risk management in this high-risk group.