title: Hypertension and type 2 diabetes: what family physicians can do to improve control of blood pressure--an observational study.
abstract: BACKGROUND
  The prevalence of type 2 diabetes is rising, and most of these patients also have hypertension, substantially increasing the risk of cardiovascular morbidity and mortality. The majority of these patients do not reach target blood pressure levels for a wide variety of reasons. When a literature review provided no clear focus for action when patients are not at target, we initiated a study to identify characteristics of patients and providers associated with achieving target BP levels in community-based practice.
  
  
  METHODS
  We conducted a practice-based, cross-sectional observational and mailed survey study. The setting was the practices of 27 family physicians and nurse practitioners in 3 eastern provinces in Canada. The participants were all patients with type 2 diabetes who could understand English, were able to give consent, and would be available for follow-up for more than one year. Data were collected from each patient's medical record and from each patient and physician/nurse practitioner by mailed survey. Our main outcome measures were overall blood pressure at target (< 130/80), systolic blood pressure at target, and diastolic blood pressure at target. Analysis included initial descriptive statistics, logistic regression models, and multivariate regression using hierarchical nonlinear modeling (HNLM).
  
  
  RESULTS
  Fifty-four percent were at target for both systolic and diastolic pressures. Sixty-two percent were at systolic target, and 79% were at diastolic target. Patients who reported eating food low in salt had higher odds of reaching target blood pressure. Similarly, patients reporting low adherence to their medication regimen had lower odds of reaching target blood pressure.
  
  
  CONCLUSIONS
  When primary care health professionals are dealing with blood pressures above target in a patient with type 2 diabetes, they should pay particular attention to two factors. They should inquire about dietary salt intake, strongly emphasize the importance of reduction, and refer for detailed counseling if necessary. Similarly, they should inquire about adherence to the medication regimen, and employ a variety of patient-oriented strategies to improve adherence.
authors.affiliation: Department of Family Medicine, Dalhousie University, Oxford Street, Halifax, Nova Scotia, Canada. wayne.putnam@dal.ca
authors.forename: Wayne
authors.initials: W
authors.lastname: Putnam
authors.forename: Beverley
authors.initials: B
authors.lastname: Lawson
authors.forename: Farokh
authors.initials: F
authors.lastname: Buhariwalla
authors.forename: Mary
authors.initials: M
authors.lastname: Goodfellow
authors.forename: Rose Anne
authors.initials: RA
authors.lastname: Goodine
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hall
authors.forename: Kendrick
authors.initials: K
authors.lastname: Lacey
authors.forename: Ian
authors.initials: I
authors.lastname: MacDonald
authors.forename: Frederick I
authors.initials: FI
authors.lastname: Burge
authors.forename: Nandini
authors.initials: N
authors.lastname: Natarajan
authors.forename: Ingrid
authors.initials: I
authors.lastname: Sketris
authors.forename: Beth
authors.initials: B
authors.lastname: Mann
authors.forename: Peggy
authors.initials: P
authors.lastname: Dunbar
authors.forename: Kristine
authors.initials: K
authors.lastname: Van Aarsen
authors.forename: Marshall S
authors.initials: MS
authors.lastname: Godwin
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005194:Family Practice; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'