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Study: Doctors Not Always Sure When to Treat Blood Pressure in People With Diabetes
Date:5/19/2008

Even when pressure is high, uncertainty stems from ambiguous standards, competing demands and overlapping health problems, U-M/VA study finds

ANN ARBOR, Mich., May 19 /PRNewswire-USNewswire/ -- For people with diabetes, high blood pressure poses a special threat, multiplying their risk of heart attacks, strokes and kidney problems.

But a new study finds that even when people with diabetes show up in their doctor's office with a high blood pressure reading, there's only a 50-50 chance that each of them will get some sort of attention for it. That might mean a change to their medications, or a plan to follow up a few weeks later to see if the reading is still high.

What happens the other 50 percent of the time? Something that others have termed "clinical inertia" takes over, say the University of Michigan Health System and VA Ann Arbor Healthcare System researchers who conducted the study, which is appearing in the May 20 issue of the Annals of Internal Medicine.

The fear is that this lack of response to high blood pressure readings at clinic visits could mean that patients' pressures will keep getting worse.

The study takes a look at possible causes of clinical inertia and finds little evidence supporting the idea that providers are just "ignoring" blood pressure problems.

What really seems to have an impact on treatment decisions is plain old uncertainty about whether the blood pressure is really elevated, or providers being occupied with other medical issues. Providers might need to spend the visit addressing more pressing problems, some of which, like pain, may be contributing to elevated blood pressures. Or, they might take another reading and conclude there's no need for action. Or, patients may report that their pressure readings at home have been fine.

More systematic guidelines for monitoring blood pressure in people with diabetes, and better guidance for when to change treatment when pressures get t
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SOURCE University of Michigan Health System
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