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. 2013 Sep 12;5(1):52.
doi: 10.1186/1758-5996-5-52.

Hypertension management algorithm for type 2 diabetic patients applied in primary care

Luciana V Viana  1 , Cristiane B Leitão, Maria F Grillo, Ennio P C C Rocha, Juliana K Brenner, Rogerio Friedman, Jorge L Gross
Affiliations

Hypertension management algorithm for type 2 diabetic patients applied in primary care

Luciana V Viana et al. Diabetol Metab Syndr. .

Abstract

Background: Hypertension frequently coexists with type 2 diabetes (DM), and increases the risk of cardiovascular outcomes. The aim of the study was to obtain/maintain blood pressure (BP) goals (ADA/JNC 7) according to a stepwise algorithm using the medication supplied by the Brazilian government.

Methods: A one-year, single-arm interventional study conducted with type 2 diabetes patients. Intervention consisted of intensification of lifestyle changes and sequential prescription of drugs: diuretic; ACE inhibitors; β-adrenergic blocking agent and calcium channel blocking agent if BP >130/80 mmHg.

Results: Seventy-eight patients completed the trial. During intervention, the number of antihypertensive tablets rose (3.6 ± 3.5 vs. 5.9 ± 3.5 pills/patient; p <0.001), as the number of antihypertensive classes increased (1.8 ± 1.0 vs. 2.70 ± 1.2; p < 0.01) and the overall drop of BP was 11 mmHg for SBP (145.0 ± 22.8 vs. 133.7 ± 20.9 mmHg; p < 0.01) and 5 mmHg for DBP (78.7 ± 11.5 vs. 73.7 ± 10.5 mmHg; p = 0.001). Although the number of patients with BP in target almost doubled [14 (18.7%) vs. 30 (38.5%) p = 0.008], less than 40% of the patients achieved the proposed goals.

Conclusions: A BP algorithm applied to type 2 diabetic and hypertensive patients is able to lower BP, however more than half of the patients did not achieve the ADA/JNC 7 targets demonstrating the complexity of BP control in this population.

Trial registration: ClinicalTrials.gov: NCT06260.

Trial registration: ClinicalTrials.gov NCT00006260.

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Figures

Figure 1
Figure 1
Blood Pressure decrease and Medication Tablets increase throughout the study: Panel A – Systolic Blood Pressure (mean ± SE); *Run-In: Systolic BP: 145.0 ± 22.8 vs. 138.8 ± 21.2 mmHg; p = 0.002; ** Intervention Systolic BP: 138.5 ± 21.21 to 132.6 ± 14.8 mmHg; P = 0.046; Panel B – Diastolic Blood Pressure (mean ± SE). +Run-In: Diastolic BP: 79.4 ± 11.5 vs. 76.5 ± 10.9; p = 0.026; ++ Intervention Diastolic BP: 76.4 ± 11.05 to 74.4 ± 8.6; P <0.01.
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