Practice and patient characteristics related to blood pressure in patients with type 2 diabetes in primary care: a cross-sectional study.
BACKGROUND
Good blood pressure control reduces the risk of long-term complications of diabetes; however, most people with diabetes do not achieve recommended blood pressure targets.


OBJECTIVE
To quantify the relationships between patient and practice factors and blood pressure in patients with type 2 diabetes.


METHODS
A cross-sectional study was carried out in 42 general practices in Nottingham. Participants were 1534 people with type 2 diabetes. Patient characteristics were assessed by a clinical interview and case note review and practice characteristics by questionnaire. The outcome measures were systolic and diastolic blood pressure.


RESULTS
In all, 46% of participants had well-controlled blood pressure (<or= 145/85 mmHg) and 68% were on anti-hypertensive treatment. Systolic and diastolic blood pressure were significantly higher in males overall, in those with a body mass index >or= 25 kg/m(2), and increased with alcohol consumption. Systolic blood pressure increased whereas diastolic blood pressure decreased with increasing age and duration of diabetes. Current smokers and ex-smokers had a significantly lower diastolic blood pressure than those who had never smoked. Patients from practices where blood pressure targets were negotiated with most patients had significantly lower mean systolic and diastolic blood pressure than those where targets were negotiated with few patients.


CONCLUSIONS
A number of patient characteristics are associated with blood pressure. Negotiating individual goals for blood pressure may be important in achieving blood pressure control in patients with type 2 diabetes. Further research is required to confirm this finding and to explore the process of negotiating targets.
Bebb
Charlotte
C
Department of Diabetes, Nottingham University Hospitals, Nottingham, UK. charlotte.bebb@nuh.nhs.uk
Coupland
Carol
C
Stewart
Jane
J
Kendrick
Denise
D
Madeley
Richard
R
Sturrock
Nigel
N
Burden
Richard
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2; D004739:England; D005194:Family Practice / Q000458:organization & administration; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*