Cor Vasa 2005, 46(4)

Hypertension and diabetes mellitus in GPs' offices. The incidence of hypertension and its control.

Jiří Widimský^1,*, Miroslav Souček², Martina Sachová³, Věra Lánská⁴

¹ Klinika kardiologie, Institut klinické a experimentální medicíny, Praha

² II. interní klinika, Fakultní nemocnice u sv. Anny, Brno

³ Servier, Praha

⁴ Úsek náměstka pro odbornou činnost, Institut klinické a experimentální medicíny, Praha, Česká republika

Aim of study:
The presence of diabetes mellitus makes the prognosis of hypertension appreciably worse in terms of development of both atherosclerotic (macrovascular) and microvascular complications. The European Society of Hypertension and European Society of Cardiology guidelines thus recommend substantially more aggressive treatment of hypertension with target BP levels below 130/80 mm Hg.
Our previous study showed a high prevalence of hypertension in the offices of 150 GPs' across the Czech Republic. The study also demonstrated poor control of hypertension as target values < 140/90 mm Hg were only achieved in 21.8% drug-treated hypertensives. Our study was designed to monitor control of hypertension in patients with diabetes attending GPs' offices.

Method:
A total of 150 GPs' in Bohemia and Moravia participated in the survey. Each GP examined and recorded the data of 15 consecutive patients (aged 45 years and over) regardless of the reason for their visit. The result was a group of 2,211 patients aged 45 years and over. For the purposes of the study, subpopulations of patients with diabetes mellitus and impaired fasting glucose level and patients without diabetes mellitus and without impaired fasting glucose level were selected.

Results:
Target BP levels of < 130/80 mm Hg were achieved in only 4.7% of diabetic patients treated by antihypertensive drugs. These data clearly show that control of hypertension in diabetics is much worse compared with hypertensive patients without diabetes mellitus.
A combination of three and more antihypertensive drugs was used in only one in five patients. While systolic BP control deteriorates significantly with age-in the age groups of 65-74 years and > 74 years-uncontrolled systolic BP ł 130 mm Hg was present in 92.4% and 93.1% of patients, respectively; the number of patients (with uncontrolled BP) was
significantly lower, 76.8%, in the youngest age bracket. Systolic BP ł 140 mm Hg in the age groups of 65-74 years and > 74 years was found in 78.6% and 75.9%, respectively; with the figure being significantly lower, 57.1%, in the youngest age group.
By contrast, diastolic BP control below 90 mm Hg does not tend to improve significantly with age. Its values < 90 mm Hg improve non-significantly with age, being reported in 56.5 to 63.2% of diabetics with hypertension; a decrease in diastolic BP < 80 mm Hg is achieved in less than 8.9 to 17.2%. The data clearly show that even control of diastolic BP to a level below 80 mm Hg is a challenge.

Conclusions:
Our study shows that a target BP < 130/80 mm Hg is only achieved by less than 5% of diabetic patients with hypertension. Our findings also show that poor control of hypertension in diabetic patients is mainly due to poor systolic BP control, deteriorating significantly with increasing age. These data are alarming and point to the necessity of more aggressive, in particular combination therapy in diabetic patients.

Keywords: Hypertension control in diabetes; Type 2 diabetes mellitus; Hypertension

Published: April 1, 2005  Show citation