The 2023 ADA guideline update was associated with negligible improvement in achieving blood pressure <130/80 mmHg (41.8% post-guideline vs 40.4% pre-guideline; SMD 0.018).
Cohort (n=53,100)
Does the publication of updated ADA guidelines recommending stricter blood pressure targets improve blood pressure control in adults with diabetes and hypertension?
Despite updated ADA guidelines recommending stricter blood pressure targets, there was negligible improvement in blood pressure control, indicating significant therapeutic inertia in clinical practice.
Standardized Mean Difference: 0.018
Absolute Event Rate: 41.8% vs 40.4%
Introduction and Objective: In November of 2022 the American Diabetes Association published the standards of care for diabetes- 2023, which included a change in blood pressure goals to less than 130/80 mmHg for all patients with diabetes regardless of age, if it can be safely attained. We assessed whether the guideline change. Methods: Retrospective pre-post cohort study from a large integrated healthcare delivery system to assess blood pressure control from January 1, 2022, through November 30, 2022 (Pre-guideline publication) compared to December 1, 2022 through December 31, 2023 (Post-guideline publication). We assessed adults (≥18 years) with comorbid diabetes and hypertension for the percentage of participants with a median blood pressure of less than 130/80 mmHg, between 130/80 mmHg-139/89 mmHg, and ≥140/90 mmHg. Secondary outcomes examined prescribing rates of antihypertensive classes, sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 agonists (GLP1) or GLP1/glucose-dependent insulinotropic polypeptide agonists (GIP). Results: We examined 24,211 individuals pre-guideline publication and 28,889 post-guideline. There was a negligible improvement in blood pressure control pre-publication (130/80, 40.4%; 130/80-139/89, 29.1%; ≥140/90, 30.5%) to post-publication (130/80, 41.8%; 130/80-139/89, 28.8%; ≥140/90, 29.4%)(SMD= 0.018). More clinically meaningful increases pre- to post-publication were found for SGLT-2i (11.2% vs 16.7%, SMD= 0.143) and GLP1/GIP (18.4% vs 25.1%, SMD= 0.158) prescribing rates while a negligible increase in the number of antihypertensive classes prescribed was found (2.2 vs 2.3, SMD= 0.047). Conclusion: Negligible improvements in blood pressure control and antihypertensive prescribing pre-to post-guideline update suggest therapeutic inertia. The more clinically meaningful increases in GLP1/GIP and SGLT-2i prescribing is encouraging and could lead to improved long-term outcomes. Disclosure J. Herges: None. A.Z. Davis: None. K.R. Neverman: None. D. Firkus: None. K. Cole: None. R. McCoy: None.
HERGES et al. (Fri,) conducted a cohort in comorbid diabetes and hypertension (n=53,100). 2023 ADA guideline update (blood pressure goal <130/80 mmHg) vs. Pre-guideline publication was evaluated on median blood pressure of less than 130/80 mmHg (SMD 0.018). The 2023 ADA guideline update was associated with negligible improvement in achieving blood pressure <130/80 mmHg (41.8% post-guideline vs 40.4% pre-guideline; SMD 0.018).
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