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Abstract

Several different blood pressure (BP) goals for diabetics have been recently promulgated by various guideline-writing groups. The Healthplan Employer Data Information Set (HEDIS) 2000 uses a goal BP of < 140/90 mm Hg; the Sixth Report of the Joint National Committee (JNC VI) recommended < 130/85 mm Hg; and the American Diabetes Association (ADA) and National Kidney Foundation (NKF) recommend < 130/80 mm Hg. To compare BP control rates using these recommendations, a chart review was performed. Among the 437 consecutive patients first seen in the Rush University Hypertension Center from September, 1998 to February, 2000 were 86 diabetics (47% male, 61 + 12 years old). The mean initial BP was 156 ± 24/ 89 ± 12 mm Hg and, after at least one year in clinic, decreased to 137 ± 16/ 78 ± 10 mm Hg at the most recent visit. Goal BP achievement varied depending on which guideline criteria were applied.

Overall, diabetic patients reached goal BP less commonly than non-diabetic patients, but the difference was statistically significant only when a lower goal BP was considered for diabetics (P < 0.001 by chi-square, using either JNC VI or ADA/NKF goals; P = 0.22 for HEDIS criteria). Similarly, the trend for controlled hypertension decreased significantly as the goal BP declined, whether or not the non-diabetics were included in the analyses (all P < 0.001). This trend was significant for both systolic (chi-square = 25, P < 0.001) and diastolic BP (chi-square =14, P < 0.001). Control of systolic BP was less commonly achieved than diastolic, regardless of which goal BP was used (P = 0.025 by chi-square). BP control among diabetics is, therefore, less common when more stringent goals are used, even among patients seen in a specialized Hypertension Center with a high prevalence of controlled hypertension. These data suggest that achieving the recently-recommended lower BP goals for diabetics, especially systolic BP < 130 mm Hg, will be a challenge. (See Table)

HEDIS Non-diabeticHEDIS- DiabeticJNC VI- DiabeticADA/NKF Diabetic
% Control %59522215
% Systolic Control63552323
% Diastolic Control86736846
HEDIS Non-diabeticHEDIS- DiabeticJNC VI- DiabeticADA/NKF Diabetic
% Control %59522215
% Systolic Control63552323
% Diastolic Control86736846
HEDIS Non-diabeticHEDIS- DiabeticJNC VI- DiabeticADA/NKF Diabetic
% Control %59522215
% Systolic Control63552323
% Diastolic Control86736846
HEDIS Non-diabeticHEDIS- DiabeticJNC VI- DiabeticADA/NKF Diabetic
% Control %59522215
% Systolic Control63552323
% Diastolic Control86736846

Hypertension Guidelines, Blood Pressure Control, Hypertension Specialist
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© American Journal of Hypertension, Ltd. 2002
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