Control of cardiovascular risk factors in patients with diabetes and hypertension at urban academic medical centers.
OBJECTIVE
There are national mandates to reduce blood pressure (BP) to <130/85 mmHg, LDL cholesterol to <100 mg/dl, and HbA(1c) to <7% and to institute aspirin therapy in patients with diabetes. The objective of this study was to determine the proportion of patients in urban institutions with diabetes and hypertension who meet these treatment goals.


METHODS
Using American Diabetes Association (ADA) guidelines, we evaluated the control of cardiovascular disease (CVD) risk factors in 1,372 patients receiving medical care at two major urban medical centers in Brooklyn and Detroit. Information was extracted from charts of outpatient clinics.


RESULTS
Of 1,372 active clinic patients with diabetes and hypertension, 1,247 (90.9%) had type 2 diabetes, and 26.7% met the target blood pressure of 130/85 mmHg. A total of 35.5% met the goal LDL cholesterol level of <100 mg/dl, 26.7% had an HbA(1c) <7%, and 45.6% were on antiplatelet therapy. Only 3.2% of patients met the combined ADA goal for BP, LDL cholesterol, and HbA(1c).


CONCLUSIONS
Optimal control of CVD risk factors in adults with diabetes was achieved only in a minority of patients. Results reflect the inherent difficulties in achieving these complex guidelines in our present health care systems.
McFarlane
Samy I
SI
Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, State University of New York, Health Science Center at Brooklyn, Brooklyn, New York 11203, USA.
Jacober
Scott J
SJ
Winer
Nathaniel
N
Kaur
Jasjeet
J
Castro
Jonathan P
JP
Wui
MaryLou A
MA
Gliwa
Agnes
A
Von Gizycki
Hans
H
Sowers
James R
JR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D008078:Cholesterol, LDL / Q000097:blood; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology*; D003971:Diastole; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009519:New York City; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D013599:Systole; D014505:Urban Population
D000806:Angiotensin-Converting Enzyme Inhibitors; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D008077:Lipoproteins, LDL; D010975:Platelet Aggregation Inhibitors