Navigation Links
Study: Doctors not always sure when to treat BP in people with diabetes
Date:5/19/2008

ANN ARBOR, Mich. 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 doctors office with a high blood pressure reading, theres 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 theres 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 too high, are needed, say the researchers. Theyre 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 Schools 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 associated with providers tendency to adjust blood pressure treatment in reaction to the high initial reading.

Their analysis revealed findings that have implications for how patients, and clinicians, measure and react to blood pressure in clinics. For instance, there was wide variation among clinics in the likelihood that providers would order a treatment change in patients with a reading over 140/90 mm Hg.

Uncertainty about what the patients blood pressure was one of the largest factors. Providers variably repeated the blood pressure check once the patient was in the exam room, and not surprisingly were much less likely to change treatment if the new reading was lower than 140/90 mm Hg. Only 13 percent of such patients had a treatment change, compared with 61 percent of those with a high second reading, or who didnt get one.

Providers clearly trust their own reading more than they do the reading taken at the clinic intake point, suggests Hofer. But there is no evidence that supports that approach. In fact, the literature suggests that provider measurements are less reliable and subject to large biases relative to independent measures by nurses using electronic blood pressure cuffs.

Additionally providers responded to their patients own report about what kind of readings he or she was getting using a home blood pressure monitor. Only 18 percent of patients who told their providers their home measurements had been below 140/90 mm Hg received a treatment change, compared with 52 percent who said their pressures at home had been high, or who didnt report at-home monitoring.

While at-home monitoring can be important, Kerr says, the fact of the matter is that there is no standard for how often to monitor and how to record home pressure readings over time. Further, patients might preferentially report only the normal blood pressures and ignore the out-of-range values.

Patients should talk to their doctors about how often to monitor and record their blood pressure and look at averages over time, she says. If their average is above the target, it might be time to change treatment.

Finally, another major factor interfering with a patients chances of getting a treatment adjustment turned out to be somewhat predictable: attention to other issues. If a patients chief reason for coming to the clinic was unrelated to their diabetes or their blood pressure for instance, if they were seeking treatment for pain they were much less likely to receive attention for their blood pressure. The same was true for clinic visits where a patients medications werent discussed.

The team is continuing its study to see how long it takes for patients to get a treatment change. They hope their work will help guide further hypertension guidelines, and standardization of clinic practices. And that, they hope, will help millions of diabetes patients protect their long-term health.


'/>"/>

Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
Source:Eurekalert

Related medicine news :

1. Study: Doctors Not Always Sure When to Treat Blood Pressure in People With Diabetes
2. Study: Patients 75 years and older with brain tumors may benefit from more aggressive treatment
3. Study: Doctors Significantly Less Likely to Provide Women with Treatments to Prevent Heart Attacks
4. New Study: Texas Seniors 4th Hardest-Hit from Proposed Bush Administration Medicare Cuts
5. Study: Most female child molesters were victims of sexual abuse
6. Study: Kids think eyeglasses make other kids look smart
7. U of M study: Online intervention paramount for reducing HIV in high-risk population
8. Study: Casual Video Games Demonstrate Ability to Relieve Stress, Improve Mood: Potential Clinical Significance Highlighted
9. Study: Counseling trauma victims causes secondary trauma
10. RIT study: Sign language interpreters at high ergonomic risk
11. U-M study: Work hassles hamper sleep
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/23/2017)... ... ... Dr. David Mahon leads Siena Dental, a comprehensive dental practice located at ... Top Patient Rated Henderson Dentist by Find Local Doctors earlier this year. ... dentists who have earned high ratings and superior patient reviews from multiple credible sources. ...
(Date:2/23/2017)... ... , ... ERT, a global data and technology company that ... leading clinical development service provider, has selected ERT’s Trial Oversight suite as its ... to an array of circumstances including the use of multiple data capture modalities ...
(Date:2/23/2017)... , ... February 23, 2017 , ... ... publication and community for those in the fight against cancer, has produced a ... their success. HRA will release top-line findings in a webinar, Defining Compassionate ...
(Date:2/23/2017)... ... (PRWEB) February ... for the nation to come together to combine its favorite ... with its favorite fruit – apples! To celebrate National Nutrition ... join the “Apple Madness” bracket tournament – a five-week, five-round ...
(Date:2/23/2017)... ... February 23, 2017 , ... Top cosmetic and periodontal dentist Dr. Mahnaz ... a new Indiegogo campaign . Individuals are now able to contribute to the ... area, either as a participating patient or through an Indiegogo donation. The entirety of ...
Breaking Medicine News(10 mins):
(Date:2/23/2017)... Feb. 23, 2017 AcelRx Pharmaceuticals, Inc. ... the development and commercialization of innovative therapies for ... it will release fourth quarter and yearly financial ... 2017. AcelRx management will host an investment-community conference ... Pacific Time) on March 2 nd 2017 ...
(Date:2/23/2017)... ... has announced the addition of the "Global Antifungal Drugs Market Analysis ... The Global Antifungal Drugs Market is poised to grow ... approximately $12.8 billion by 2025. This industry report ... global as well as regional levels presented in the research scope. The ...
(Date:2/23/2017)... 2017 The top three players ... Healthcare, Koninklijke Philips N.V., and Schiller. Collectively, these companies ... market in 2015. Strong product portfolio and a monumental ... be aiding these players remain leaders in the fragmented ... in the global market are likely to focus on ...
Breaking Medicine Technology: