Control of Arterial Hypertension among Type 2 Diabetics

Ylber Jani, MD,PhD¹*; Amet Kamberi,MD,PhD¹; Dali Lala,MD²; Gafur Polisi,MD³; Mair Iseni,MD^; Arben Mirto,MDᶿ; Fatmir Ferati,MD,PhD"; Agim Zeqiri,MD°; Atila Rexhepi,MD,PhD"; Nikola Orovcanec,MD,PhD°°.

¹Private Health Institute of family medicine “Herat Diagnostika”, Debar; ²Private Health Institute of family medicine “Florenc”, Tetovo; ³Private Health Institute of family medicine-“Polisi”, Struga; ^Private Health Institute of family medicine“Poli-Medika”, Gostivar; ᶿPrivate Health Institute of family medicine “DR.Mirto, Gostivar; "Department of Internal Medicine Faculty of Medicine, Tetovo; °General Hospital “DR Ferit Murat”, Gostivar; °Instituteof Biostatistics, Faculty of Medicine, “Ss Kiril and Metodij” University, Skopje; Republic of Macedonia

*Corresponding author: Ylber Jani, MD, PhD. Private Health Institute of family medicine “Herat Diagnostika”, Debar, Republic of Macedonia. E-mail: vera@mt.net.mk

Published: December 25, 2013 

Abstract: 

Arterial hypertension (AH) frequently coexists with diabetes mellitus, occurring twice as frequently in diabetics as in the nondiabetic subjects. AH in diabetic patients is a well-recognized cardiovascular risk factor, accounting for up to 75% of additional cardiovascular disease risks, contributing significantly to the overall morbidity and mortality in this high-risk population. Patients with both disorders are prone to a markedly higher risk for premature microvascular and macrovascular complications. According to the intervention studies, the benefits that accrue after treatment is evidence based. Aggressive blood pressure (BP) control reduces both macrovascular and microvascular complications. A report of the Joint National Committee (JNC 7) on prevention, detection, evaluation and treatment of high blood pressure concluded that the blood pressure measurement  in diabetic patients, should be less than 130/80mmHg. Blood pressure is poorly controlled in most European countries and the control rate is even lower in high-risk patients, particularly in diabetic patients. Primary healthcare physicians play a very important role in treating hypertensive patients, as most of them are being followed up at the primary healthcare clinics.

The objective of this study was to determine the degree of BP control in hypertensive diabetics, according to the evidence and current guidelines, in a cohort of hypertensive diabetics, who were under general practitioner care.

Material and Methods: The study was conducted at outpatient in the health care clinics. Data was collected by 12 physicians, on 600 patients with type 2 diabetes mellitus (T2DM) and AH, seen in the clinics, during the period of study between March 2012 and March 2013. Patient demographic, clinical, and laboratory characteristics and drug usage were obtained. Patients were classified under four groups based on the degree of systolic and diastolic blood pressure control.

Results: A total of 600 patients (45.6% females and 54.3% males; mean age: 62±5.8 years) were included in the study. The mean duration of the diabetes was 5.2±2.0 years. Poor control of AH was observed among 71.4% of the cases. Only 28.6% of the diabetic patients were found to have controlled blood pressure, and the difference was found to be statistically significant (p<0.001). Angiotensin-сonverting enzyme (ACE) inhibitors were used in 55% of the subjects, while angiotensin receptor blockers (ARB) were used in 34%; beta-blockers were given in 37.6% of cases, whereas calcium channels blockers (CCB) were given to 30.3%, and diuretics were administered in 22.6% of the cases.

Conclusion: Only 28.3% of the hypertensive diabetics met the recommended BP values for diabetes. More efforts are required, addressed particularly to control the BP in diabetics. More aggressive therapy by the physicians concerned could improve blood pressure control and thus reduce the cardiovascular morbidity and mortality. As the adequate control of the BP usually warrants more than one medication, physicians should be careful when selecting hypertensive medications, because some combinations are not beneficial.

Keywords: 
arterial hypertension; type 2 diabetes mellitus; blood pressure control.
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