title: Determinants of sustained uncontrolled blood pressure in a national cohort of persons with diabetes.
abstract: BACKGROUND
  Randomized clinical trials have demonstrated that strict blood pressure (BP) control in diabetes reduces cardiovascular morbidity and mortality. Previous observational studies have confirmed that hypertension is inadequately controlled in the general population of the United States. In this study we evaluated the prevalence and determinants of severe, sustained, uncontrolled hypertension in a national cohort of persons with diabetes.
  
  
  METHODS
  We identified 64,105 veterans from the national Veterans Administration diabetes registry for whom BP, survey, laboratory, and medication data were available. Using mean BP from three visits in fiscal year 2000, we determined the prevalence of sustained BP readings > or = 160/100, > or = 140/90, or > or = 130/80 mm Hg. We determined predictors of the three thresholds using demographic variables, self-reported medical comorbidities, estimated glomerular filtration rate, and number of BP-lowering medications.
  
  
  RESULTS
  Over a mean interval of 131.0 days (+/-81.4), we found that 6,347 (9.9%) of the 64,105 veterans with diabetes had mean BP > or = 160/100 mm Hg. Similarly 25,924 (40.4%) had a mean BP > or = 140/90 mm Hg, and 38,296 (59.7%) had a mean BP > or = 130/80 mm Hg. Independent predictors of mean BP > or = 160/100 mm Hg included age, ethnicity, education level, cardiovascular comorbidities, alcohol use, and number of BP-lowering medications.
  
  
  CONCLUSIONS
  Administrative databases can be used to identify patients with sustained uncontrolled hypertension within health care systems. Our findings suggest important patient-level factors that can be targeted for quality improvement programs in diabetes.
authors.affiliation: Department of Veterans Affairs-New Jersey Healthcare System, East Orange, New Jersey 07018, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Greenberg
authors.forename: Anjali
authors.initials: A
authors.lastname: Tiwari
authors.forename: Mangala
authors.initials: M
authors.lastname: Rajan
authors.forename: Donald
authors.initials: D
authors.lastname: Miller
authors.forename: Sundar
authors.initials: S
authors.lastname: Natarajan
authors.forename: Leonard
authors.initials: L
authors.lastname: Pogach
mesh_terms: D000367:Age Factors; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D014728:Veterans