Diagnosis and Treatment of Incident Hypertension Among Patients with Diabetes: a U.S. Multi-Disciplinary Group Practice Observational Study

Margaret L. Wallace, Elizabeth Magnan, Carolyn T. Thorpe, Jessica R. Schumacher, Maureen A. Smith, Heather M. Johnson

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: Early hypertension control reduces the risk of cardiovascular complications among patients with diabetes mellitus. There is a need to improve hypertension management among patients with diabetes mellitus. OBJECTiVE: We aimed to evaluate rates and associations of hypertension diagnosis and treatment among patients with diabetes mellitus and incident hypertension. DESIGN: This was a 4-year retrospective analysis of electronic health records. PARTICIPANTS: Adults ≥18 years old (n = 771) with diabetes mellitus, who met criteria for incident hypertension and received primary care at a large, Midwestern academic group practice from 2008 to 2011 were included MAIN MEASURES: Cut-points of 130/80 and 140/90 mmHg were used to identify incident cases of hypertension. Kaplan-Meier analysis estimated the probability of receiving: 1) an initial hypertension diagnosis and 2) antihypertensive medication at specific time points. Cox proportional-hazard frailty models (HR; 95 % CI) were fit to identify associations of time to hypertension diagnosis and treatment. KEY RESULTS: Among patients with diabetes mellitus who met clinical criteria for hypertension, 41 % received a diagnosis and 37 % received medication using the 130/80 mmHg cut-point. At the 140/90 mmHg cut-point, 52 % received a diagnosis and 49 % received medication. Atrial fibrillation (HR 2.18; 1.21–4.67) was associated with faster diagnosis rates; peripheral vascular disease (HR 0.18; 0.04–0.74) and fewer primary care visits (HR 0.93; 0.88–0.98) were associated with slower diagnosis rates. Atrial fibrillation (HR 3.07; 1.39–6.74) and ischemic heart disease/congestive heart failure (HR 2.16; 1.24–3.76) were associated with faster treatment rates; peripheral vascular disease (HR 0.16; 0.04–0.64) and fewer visits (HR 0.93; 0.88–0.98) predicted slower medication initiation. Diagnosis and treatment of incident hypertension were similar using cut-points of 130/80 and 140/90 mmHg. CONCLUSIONS: Among patients with diabetes mellitus, even using a cut-point of 140/90 mmHg, approximately 50 % remained undiagnosed and untreated for hypertension. Future interventions should target patients with multiple comorbidities to improve hypertension and diabetes clinical care.

Original languageEnglish (US)
Pages (from-to)768-776
Number of pages9
JournalJournal of General Internal Medicine
Volume30
Issue number6
DOIs
StatePublished - Jun 26 2015
Externally publishedYes

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Group Practice
Observational Studies
Hypertension
Diabetes Mellitus
Therapeutics
Peripheral Vascular Diseases
Atrial Fibrillation
Primary Health Care
Electronic Health Records
Kaplan-Meier Estimate
Proportional Hazards Models
Antihypertensive Agents
Myocardial Ischemia
Comorbidity
Heart Failure

Keywords

  • diabetes mellitus
  • diagnosis
  • electronic health records
  • hypertension

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Diagnosis and Treatment of Incident Hypertension Among Patients with Diabetes : a U.S. Multi-Disciplinary Group Practice Observational Study. / Wallace, Margaret L.; Magnan, Elizabeth; Thorpe, Carolyn T.; Schumacher, Jessica R.; Smith, Maureen A.; Johnson, Heather M.

In: Journal of General Internal Medicine, Vol. 30, No. 6, 26.06.2015, p. 768-776.

Research output: Contribution to journalArticle

Wallace, Margaret L. ; Magnan, Elizabeth ; Thorpe, Carolyn T. ; Schumacher, Jessica R. ; Smith, Maureen A. ; Johnson, Heather M. / Diagnosis and Treatment of Incident Hypertension Among Patients with Diabetes : a U.S. Multi-Disciplinary Group Practice Observational Study. In: Journal of General Internal Medicine. 2015 ; Vol. 30, No. 6. pp. 768-776.
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N2 - BACKGROUND: Early hypertension control reduces the risk of cardiovascular complications among patients with diabetes mellitus. There is a need to improve hypertension management among patients with diabetes mellitus. OBJECTiVE: We aimed to evaluate rates and associations of hypertension diagnosis and treatment among patients with diabetes mellitus and incident hypertension. DESIGN: This was a 4-year retrospective analysis of electronic health records. PARTICIPANTS: Adults ≥18 years old (n = 771) with diabetes mellitus, who met criteria for incident hypertension and received primary care at a large, Midwestern academic group practice from 2008 to 2011 were included MAIN MEASURES: Cut-points of 130/80 and 140/90 mmHg were used to identify incident cases of hypertension. Kaplan-Meier analysis estimated the probability of receiving: 1) an initial hypertension diagnosis and 2) antihypertensive medication at specific time points. Cox proportional-hazard frailty models (HR; 95 % CI) were fit to identify associations of time to hypertension diagnosis and treatment. KEY RESULTS: Among patients with diabetes mellitus who met clinical criteria for hypertension, 41 % received a diagnosis and 37 % received medication using the 130/80 mmHg cut-point. At the 140/90 mmHg cut-point, 52 % received a diagnosis and 49 % received medication. Atrial fibrillation (HR 2.18; 1.21–4.67) was associated with faster diagnosis rates; peripheral vascular disease (HR 0.18; 0.04–0.74) and fewer primary care visits (HR 0.93; 0.88–0.98) were associated with slower diagnosis rates. Atrial fibrillation (HR 3.07; 1.39–6.74) and ischemic heart disease/congestive heart failure (HR 2.16; 1.24–3.76) were associated with faster treatment rates; peripheral vascular disease (HR 0.16; 0.04–0.64) and fewer visits (HR 0.93; 0.88–0.98) predicted slower medication initiation. Diagnosis and treatment of incident hypertension were similar using cut-points of 130/80 and 140/90 mmHg. CONCLUSIONS: Among patients with diabetes mellitus, even using a cut-point of 140/90 mmHg, approximately 50 % remained undiagnosed and untreated for hypertension. Future interventions should target patients with multiple comorbidities to improve hypertension and diabetes clinical care.

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