title: Patients with non-insulin depending diabetes mellitus and metabolic syndrome are suboptimal treated in Swiss primary care.
abstract: The prevalence of complicated hypertension is increasing in America and Europe. This survey was undertaken to assess the status quo of primary care management of hypertension in patients with the high-risk comorbid diseases metabolic syndrome (MetS) and/or type 2 diabetes mellitus (non-insulin depending diabetes mellitus (NIDDM)). Data of anti-hypertensive treatment of 4594 Swiss patients were collected over 1 week. We identified patients with exclusively NIDDM (N = 95), MetS (N = 168), and both (N = 768). Target blood pressure (TBP) attainment, frequency of prescribed substance-classes, and correlations to comorbidities/end-organ damages were assessed. In addition, we analyzed the prescription of unfavorable beta-blockers (BB) and high-dose diuretics (Ds). In NIDDM, Ds (61%), angiotensin receptor blockers (ARBs) (40%), and angiotensin converting enzyme inhibitors (ACEIs) (31%) were mostly prescribed, while in MetS, drugs prevalence was Ds (68%), ARBs (48%), and BB (41%). Polypharmacy in patients with MetS correlated with body mass index; older patients (>65 years) were more likely to receive dual-free combinations. TBP was attained in 25.2% of NIDDM and in 28.7% of MetS patients. In general, low-dose Ds use was more prevalent in NIDDM and MetS, however, overall, Ds were used excessively (NIDDM: 61%, MetS: 68%), especially in single-pill combination. Patients with MetS were more likely to receive ARBs, ACEIs, CCBs, and low-dose Ds than BBs and/or high-dose Ds. Physicians recognize DM and MetS as high-risk patients, but select inappropriate drugs. Because the majority of patients may have both, MetS and NIDDM, there is an unmet need to define TBP for this specific population considering the increased risk in comparison to patients with MetS or NIDDM alone.
authors.affiliation: Department of Anatomy II, Friedrich-Schiller University , Jena , Germany.
authors.forename: Hans Hendrik
authors.initials: HH
authors.lastname: Schäfer
authors.forename: Jacob Daniel
authors.initials: JD
authors.lastname: de Villiers
authors.forename: Ulrich
authors.initials: U
authors.lastname: Lotze
authors.forename: Elena
authors.initials: E
authors.lastname: Sivukhina
authors.forename: Michel
authors.initials: M
authors.lastname: Burnier
authors.forename: Georg
authors.initials: G
authors.lastname: Noll
authors.forename: Gian-Reto
authors.initials: GR
authors.lastname: Theus
authors.forename: Thomas
authors.initials: T
authors.lastname: Dieterle
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000145:classification / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D016022:Case-Control Studies; D015897:Comorbidity; D003625:Data Collection; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D004232:Diuretics / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D024821:Metabolic Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D008875:Middle Aged; D011320:Primary Health Care; D013557:Switzerland / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D004232:Diuretics