Hypertension Treatment and Control in Canadians with Diabetes.

Abstract

Objective: We investigated hypertension control (<130/80 mmHg) among individuals with diabetes, use of first-line antihypertensive medications, and physician responses to uncontrolled blood pressure (BP) measurements (i.e. repeat measurements and medication intensification).

Methods: We performed a descriptive retrospective cohort study of adults with prevalent diabetes and hypertension followed in Ontario primary care practices, from their first BP measurement 2013-2017, using the IQVIA dataset. We characterized baseline BP control and anti-hypertensive therapy, and followed individuals over 24 months. We followed a nested cohort of individuals with uncontrolled BP readings (≥130/80 mmHg) to ascertain the frequency of guideline-concordant care, consisting of repeat BP assessment and drug intensification (dose increase, additional drug class prescription) within 6 weeks.

Results: Of 10,814 included adults, 7,437 (69%) had BP ≥130/80 mmHg (46% with BP≥140/90 mmHg). Baseline mean BP was 139.4/84.4 mm Hg, and appeared similar at 24 months. At baseline, most individuals were receiving monotherapy (60%), with 90% prescribed renin-angiotensin-aldosterone system inhibitors. Only 34% of individuals were prescribed dihydropyridine calcium channel blockers and 24% were prescribed thiazide/thiazide-like diuretics. Physicians infrequently arranged timely (within 6 weeks) repeat BP checks (50%), dose increases (18%), and medication additions (33%) after uncontrolled BP readings.

Conclusion: The large majority of people with diabetes and hypertension had uncontrolled BP that persisted over 2 years. Therapeutic inertia, lack of follow-up, and under-prescribing of dual and triple combination therapy contribute to persistently high BP and represent opportunities for improvement.