BACKGROUND: Hypertension is extremely prevalent in patients with diabetes. Limited data exist on whether patterns of antihypertensive
use in this population are consistent with evidence-based practice guidelines.
OBJECTIVE: To evaluate utilization patterns of antihypertensive agents and blood pressure (BP) control among diabetic patients with
hypertension.
DESIGN: Retrospective cohort study.
PATIENTS/PARTICIPANTS: In all, 9,975 patients with diabetes and hypertension as of March 2001 from an outpatient medical center of the Department
of Veterans Affairs.
MEASURES: Proportions of use of 6 different antihypertensive drug classes were compared for all patients receiving 1, 2, 3, or 4 or
more drugs, and separately among patients with and without coronary artery disease (CAD). Blood pressure control (<130/85
mmHg) was compared for untreated patients, those on monotherapy, and patients on multidrug regimens.
RESULTS: Over 60% of patients were receiving angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blocker (ARB),
followed by diuretics (38.1%), calcium channel blockers (35.3%) and β-blockers (28.5%) with 19.1% of patients untreated. Patients
on monotherapy were mostly receiving ACEI/ARB (59.5%). The majority (70.7%) of treated patients were on multidrug regimens.
In patients with CAD, β-blocker and ACEI/ARB use was higher, and 70.5% of patients on single-drug regimens received either
ACEI/ARB or β-blockers. The proportions of patients not on medications, on monotherapy, or multidrug regimens achieving BP
control were 23.4%, 27.4%, and 24.9%, respectively.
CONCLUSIONS: Patterns of anti-hypertensive therapy were generally consistent with evidence-based practice guidelines. Areas of improvement
include increasing ACEI/ARB and diuretic use, decreasing the number of untreated patients, and increasing the proportion of
patients with controlled BP in this population.
Key Words hypertension control - diabetes - multidrug regimens - prescribing patterns - evidence base
The authors have no conflicts of interest to report.
This manuscript is based on an abstract presented at the Society of General Internal Medicine 27th annual meeting, Chicago,
Ill, April 2004. Johnson ML, Singh H. “Prescribing trends for evidence based therapies to treat hypertension in patients with
diabetes.”
Dr. Johnson, research health science specialist and VA career development awardee (Merit Review Entry Program) is employed
in the Research Care Line, Michael E. DeBakey VA Medical Center at the time of this work. Dr. Singh is employed in the Medical
Care Line, Michael E. DeBakey VA Medical Center at the time of this work.
The views expressed in this article are those of the authors and do not necessarily represent the views of the Department
of Veterans Affairs.
This research is supported in part by the Department of Veterans Affairs, Health Services Research and Development Service,
and by a grant from Pfizer, Inc.