What is the clinical evidence from this study?

Study design: Observational. Population: Hypertension in patients with diabetes. Intervention: Publication of new JNC VI and VII guidelines vs. Patients without diabetes (time trend control). Primary outcome: Hypertension control (blood pressure <140/90 mmHg) (p=< 0.001).

December 27, 2006Open Access

Lack of Effect of Guideline Changes on Hypertension Control for Patients With Diabetes in the U.S., 1995–2005

Q: What are the key findings of this study?

Publication of new JNC guidelines did not substantially improve hypertension control for diabetic patients, showing only a ~4% increase compared to nondiabetic visits after 2001 (P<0.001).

YWY. Richard WangTemple University Hospital

Key Result

Publication of new JNC guidelines did not substantially improve hypertension control for diabetic patients, showing only a ~4% increase compared to nondiabetic visits after 2001 (P<0.001).

Study Design

Type

Observational

Multicenter

Yes

Structured PICO

Does the publication of new JNC guidelines improve hypertension control in patients with diabetes in the U.S.?

Population

Outpatient visits in the U.S. during 1995-2005 from the National Disease and Therapeutic Index, comparing diabetic and nondiabetic visits.

Intervention

Publication of JNC VI (1997) and VII (2003) guidelines setting more aggressive goal blood pressure for patients with diabetes.

Comparator

Nondiabetic visits (used as the control group for the time trend).

Outcome

Hypertension control (blood pressure <140/90 mmHg).surrogate

The publication of more aggressive JNC guidelines did not substantially improve hypertension control in diabetic patients compared to nondiabetic patients in the U.S.

Main Result

p-value: p=< 0.001

Abstract

OBJECTIVE: To study the effect of new Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) guidelines on hypertension control for patients with diabetes in the U.S. using patients without diabetes as the control group for the time trend. RESEARCH DESIGN AND METHODS: The JNC VI and VII guidelines, published in 1997 and 2003, set more aggressive goal blood pressure for patients with diabetes. Data from the National Disease and Therapeutic Index, a nationally representative survey of outpatient visits in the U.S., was used to compare the difference in hypertension control (blood pressure <140/90 mmHg) between diabetic and nondiabetic visits during 1995-2005. RESULTS: Hypertension control improved for both diabetic and nondiabetic visits in the study period. Compared with nondiabetic visits, there was no change in hypertension control for diabetic visits before 2001 and an approximately 4% increase afterward (P < 0.001). CONCLUSIONS: The publication of new JNC guidelines did not result in substantially better hypertension control for patients with diabetes in the U.S.

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