title: A statewide primary care approach to cardiovascular risk factor control in high-risk diabetic and nondiabetic patients with hypertension.
abstract: Patients with multiple cardiovascular risk factors benefit from having them all controlled, but this rarely occurs. Fifty-seven primary care providers were enrolled in a program to monitor cardiovascular risk factor control. Data were obtained on 7315 hypertensives. This analysis focuses on 3460 high-risk hypertensives including 2199 with diabetes and 1261 with clinical cardiovascular disease. Blood pressures were <140/90 mm Hg and <130/80 mm Hg in only 44.3% and 20.4% of diabetics and 49.6% and 26.6% nondiabetics, respectively, despite the use of an average of 2.7+/-1.8 antihypertensive medications. Among high-risk dyslipidemic hypertensives, the low-density lipoprotein cholesterol level was <100 mg/dL in only 34% of diabetic and 33% of nondiabetic patients. Among 1696 diabetic hypertensives, the most recent glycosylated hemoglobin value averaged 7.5%, with 46.6% less than 7%. Among 805 diabetic, dyslipidemic hypertensives, all three risk factors were controlled to goal in only 6.6% with higher rates in whites than in African Americans (14.8% vs. 1.6%, p<0.001). An angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, or both were prescribed in 89.9% of diabetic and 70.8% of nondiabetic patients, p<0.05. Primary care providers use evidence-based combination therapy in high-risk hypertensive patients with and without diabetes. These findings confirm the low rates of multiple risk factor control and highlight challenges of reaching evidence-based goals in primary care.
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, SC and the Ralph H. Johnson VA Medical Center, Charleston, SC 29401-5703, USA. jan.basile@med.va.gov
authors.forename: Jan N
authors.initials: JN
authors.lastname: Basile
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Lackland
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Basile
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Riehle
authors.forename: Brent M
authors.initials: BM
authors.lastname: Egan
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000187:drug effects; D003628:Database Management Systems / Q000706:statistics & numerical data*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D011320:Primary Health Care / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D013022:South Carolina
chemical_list: D000959:Antihypertensive Agents; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin