title: Blood Pressure Control Has Improved in People with and without Type 2 Diabetes but Remains Suboptimal: A Longitudinal Study Based on the German DIAB-CORE Consortium.
abstract: BACKGROUND
  Hypertension is a very common comorbidity and major risk factor for cardiovascular complications, especially in people with Type 2 Diabetes (T2D). Nevertheless, studies in the past have shown that blood pressure is often insufficiently controlled in medical practice. For the DIAB-CARE study, we used longitudinal data based on the German DIAB-CORE Consortium to assess whether health care regarding hypertension has improved during the last decade in our participants.
  
  
  METHODS
  Data of the three regional population-based studies CARLA (baseline 2002-2006 and follow-up 2007-2010), KORA (baseline 1999-2001 and follow-up 2006-2008) and SHIP (baseline 1997-2001 and follow-up 2002-2006) were pooled. Stratified by T2D status we analysed changes in frequencies, degrees of awareness, treatment and control. Linear mixed models were conducted to assess the influence of sex, age, study, and T2D status on changes of systolic blood pressure between the baseline and follow-up examinations (mean observation time 5.7 years). We included 4,683 participants aged 45 to 74 years with complete data and accounted for 1,256 participants who were lost to follow-up by inverse probability weighting.
  
  
  RESULTS
  Mean systolic blood pressure decreased in all groups from baseline to follow-up (e.g. - 8.5 mmHg in those with incident T2D). Pulse pressure (PP) was markedly higher in persons with T2D than in persons without T2D (64.14 mmHg in prevalent T2D compared to 52.87 mmHg in non-T2D at baseline) and did not change much between the two examinations. Awareness, treatment and control increased considerably in all subgroups however, the percentage of those with insufficiently controlled hypertension remained high (at about 50% of those with hypertension) especially in prevalent T2D. Particularly elderly people with T2D often had both, high blood pressure ≥140/90 mmHg and a PP of ≥60 mmHg. Blood pressure in men had improved more than in women at follow-up, however, men still had higher mean SBP than women at follow-up.
  
  
  CONCLUSIONS
  Blood pressure management has developed positively during past years in Germany. While hypertension prevalence, awareness and treatment were substantially higher in participants with T2D than in those without T2D at follow-up, hypertension control was achieved only in about half the number of people in each T2D group leaving much room for further improvement.
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; German Center for Diabetes Research (DZD e.V.), Partner Neuherberg, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
authors.forename: Ina-Maria
authors.initials: IM
authors.lastname: Rückert
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; German Center for Diabetes Research (DZD e.V.), Partner Neuherberg, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Baumert
authors.affiliation: German Center for Diabetes Research (DZD e.V.), Partner Neuherberg, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
authors.forename: Michaela
authors.initials: M
authors.lastname: Schunk
authors.affiliation: German Center for Diabetes Research (DZD e.V.), Partner Neuherberg, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Holle
authors.affiliation: Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Schipf
authors.affiliation: Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; DZHK-German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany.
authors.forename: Henry
authors.initials: H
authors.lastname: Völzke
authors.affiliation: Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kluttig
authors.affiliation: Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany; German Cancer Research Centre, Division of Cancer Epidemiology, Heidelberg, Germany.
authors.forename: Karin-Halina
authors.initials: KH
authors.lastname: Greiser
authors.affiliation: Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
authors.forename: Teresa
authors.initials: T
authors.lastname: Tamayo
authors.affiliation: Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rathmann
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; German Center for Diabetes Research (DZD e.V.), Partner Neuherberg, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany.
authors.forename: Christa
authors.initials: C
authors.lastname: Meisinger
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000517:prevention & control*; D005260:Female; D005858:Germany; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000517:prevention & control*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents