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

oo high, are needed, say the researchers. They're led by Eve Kerr, M.D., MPH, and Timothy Hofer, M.D., M.S., of the Center for Clinical Management Research at the VA Ann Arbor Healthcare System and U-M Medical School's Division of General Medicine.

In the meantime, says Kerr, "While there are many guidelines about treating hypertension, there is an amazing lack of clarity and guidance about how many blood pressures should be taken at a clinic visit, whether those blood pressures should be averaged or whether just the lowest should be used, and how to incorporate home blood pressure readings in decisions to intensify medications. As long as this confusion exists, we may not make progress in treating hypertension."

The study was performed among 1,169 people with diabetes who were seen in VA primary care clinics over a one-year period, at nine different sites in three states.

All the patients had a blood pressure reading over 140/90 mm Hg at the start of their clinic visits. The national goal for people with diabetes is less than 130/80 mm Hg. (For people without diabetes or kidney problems, the goal is less than 140/90, which is considered the cutoff for Stage I hypertension.)

Of these patients, 573, or 49 percent, received a change in their blood pressure treatment at the same clinic visit - either a new prescription for a medication, a change in the dosage of an existing medication or medications, or a documented plan to follow up within four weeks. While this rate is higher than has been reported in other settings, there still appears to be room for improvement.

As part of the study, the researchers asked both patients and providers to complete brief questionnaires before the end of the day of the clinic visit. Most of the 92 providers who saw the patients were physicians, but they also included nurse practitioners and physician assistants. This prospective design allowed the researchers to look at all the different variables asso
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SOURCE University of Michigan Health System
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