Only half of patients had their therapy changed as needed, study found
MONDAY, May 19 (HealthDay News) -- Diabetics with high blood pressure have only a 50-50 chance that their doctors will change their medications as needed or offer other treatment, a new study finds.
Treating high blood pressure in people with diabetes is very important, because elevated pressure can lead to increased risk for heart attack, stroke and kidney problems associated with diabetes, the researchers explained.
"We wanted to understand when doctors would respond to an elevated blood pressure, by changing the patient's medication or scheduling a very close follow-up," said lead researcher Dr. Eve Kerr, an associate professor of internal medicine at the University of Michigan Medical School.
"We found that primary-care providers change treatment for blood pressure about 50 percent of the time. Fifty percent is actually higher than what has been found in previous studies. Many studies have found treatment changes only 20 to 30 percent of the time," said Kerr, who's also with the Center for Clinical Management Research at the VA Ann Arbor Healthcare System in Michigan.
The report on high blood pressure, which is also called hypertension, is published in the May 20 issue of the Annals of Internal Medicine.
For the study, Kerr and her colleagues collected data on 1,169 people with diabetes who received care from the U.S. Veterans Administration during a one-year period. The patients were seen at nine different sites in three states.
At the start of the study, all patients had high blood pressure, which is defined as 140/90 mm Hg or higher. The blood pressure goal for people with diabetes is 130/80 mm Hg.
Among the patients in the study, 49 percent had their blood pressure treatment changed during a clinic visit. The change consisted of either a new medication, a change in dose of a current medication, or a plan to follow up within a month.
"In many ways, blood pressure is getting more attention in diabetic patients than it has in the past, which is a very good thing," Kerr said. "But unfortunately, we found that many providers did not have a systematic approach to determining when a blood pressure was truly elevated and when medication should be changed."
She noted that many doctors in the study only took one blood pressure reading during a patient's visit. In some cases, when more than one reading was taken, the results weren't compared. Also, many doctors didn't take into consideration home blood pressure measurements reported by the patients.
"Without clear guidance as to how to incorporate those additional blood pressure measurements into the decision-making, it could lead to inadequate treatment of hypertension," Kerr said.
Dr. Lawrence S. Phillips, who's with the Emory University School of Medicine Division of Endocrinology and wrote an accompanying editorial in the journal, thinks doctors need to be more aggressive in treating blood pressure.
"Hypertension is a treatable problem that has a major impact on health," he said. "It's the most important health problem about which we don't do as well as we could."
One of the main problems is that doctors don't start or change therapy as often or as aggressively as they should, Phillips said. "We call that 'clinical inertia,'" he said.
Phillips thinks doctors should intensify treatment every time blood pressure is high. And blood pressure should be the first thing doctors look at during a patient's visit, and it should be treated before moving on to other problems, he said.
Patients can play a role, too, Phillips added. "Patients should ask their providers: What is my blood pressure goal? Am I at goal? If I am not, what should we do about it?" he said.
To learn more about diabetes and high blood pressure, visit the American Diabetes Association.
SOURCES: Eve Kerr, M.D., M.P.H., Center for Clinical Management Research, VA Ann Arbor Healthcare System, and associate professor, internal medicine, University of Michigan Medical School, Ann Arbor; Lawrence S. Phillips, M.D., Division of Endocrinology, Emory University School of Medicine, Atlanta; May 20, 2008, Annals of Internal Medicine
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