The need for improved medical management of patients with concomitant hypertension and type 2 diabetes mellitus.

OBJECTIVES: To determine level of blood pressure (BP) control and to evaluate hypertension management strategies in patients with hypertension and type 2 diabetes mellitus. STUDY DESIGN: Retrospective review of 2 consecutive years of pharmacy and medical insurance claims data and medical charts from patients participating in 10 health plans in 9 states. PATIENTS AND METHODS: Patients 18 years and older with a medical or pharmacy claim related to hypertension were identified and assessed for inclusion in the database. A random sample of medical charts was reviewed to confirm the diagnoses of hypertension and diabetes mellitus and degree of BP control and to assess the prevalence of other cardiovascular disease risk factors and current antihypertensive treatment. RESULTS: Type 2 diabetes mellitus was documented in 977 patients. The mean age was 64.3 years, and 55.1% were women. A BP goal of less than 130/85 mm Hg was achieved in 192 patients (19.7%), and a BP goal of less than 130/80 mm Hg was achieved in 135 patients (13.8%). Fifty-two percent of patients had dyslipidemia, and 87.6% were overweight, obese, or morbidly obese; tobacco use was documented in 19.5%. CONCLUSIONS: Hypertensive diabetic patients are frequently not treated to their goal BP, which requires the use of 2 or more agents in most patients. Quality improvement programs should emphasize the importance of treating hypertensive diabetic patients to their goal BP, as well as controlling other major cardiovascular disease risk factors, such as smoking, dyslipidemia, and overweight or obesity, that are prevalent among these high-risk patients.

Effect of a primary care physician-focused, population-based approach to blood pressure control.

BACKGROUND AND OBJECTIVES: A large majority of hypertensive patients are cared for in primary care settings, and most of them do not have adequately controlled blood pressure. AvMed Health Plan, a large Florida-based, nonprofit, physician network health maintenance organization, initiated a program to assist primary care physicians to achieve a greater degree of blood pressure control in their hypertensive patients. Concomitantly, a study was designed to determine whether this physician-focused intervention improved blood pressure control in these patients. METHODS: Data were collected from pharmacy claims and medical charts for random samples of treated hypertensive patients prior to and following a 6-month educational intervention aimed at providers. Analysis of the data sets was conducted to determine what percentage of subjects achieved target blood pressure goals before and after the intervention. RESULTS: At baseline, 41% of the total population had achieved a target blood pressure of <140/90 mm Hg; 52% achieved this goal following the intervention. When target blood pressure goals were defined as <140/90 mm Hg for nondiabetic subjects and < 130/85 mm Hg for diabetic subjects, 36% of the total population achieved target blood pressure goals at baseline; 47% achieved these goals following the intervention. CONCLUSIONS: A physician-focused intervention significantly improved blood pressure control in diabetic and nondiabetic hypertensive patients enrolled in AvMed Health Plan.