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Clinical Decisionmaking

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Lifestyle changes could improve blood pressure control in people who have diabetes

Nearly 60 percent of adults with diabetes have coexisting hypertension, doubling their risk for cardiovascular problems. Adults with diabetes, regardless of sex and race/ethnicity, apparently listen when doctors advise them to lose weight and use medications to reduce their high blood pressure. They are less likely, however, to follow their doctor's advice to get more exercise, according to Leonard E. Egede, M.D., M.S., of the Medical University of South Carolina.

In a recent study that was supported by the Agency for Healthcare Research and Quality (K08 HS11418), Dr. Egede analyzed data from the 1998 National Health Interview Survey, a national household survey of nonmilitary and noninstitutionalized people in the United States. He specifically analyzed data on risk factors for cardiovascular disease (CVD), such as hypertension, high cholesterol, smoking, and obesity among 19,672 people without diabetes and 1,609 people with diabetes. He compared the prevalence of physician advice and patients' reported adherence to it among 989 adults with diabetes and hypertension and 5,030 adults who had hypertension but not diabetes.

Contrary to prevailing physicians' assumptions that most patients are unwilling to change negative health habits and that counseling is ineffective in modifying CVD risk behavior, physician advice seemed effective in modifying some hypertension risk behaviors among people with diabetes. Controlling for other factors, hypertensive patients with diabetes were twice as likely as those without diabetes to receive advice on weight loss, exercise, and antihypertensive medications. People with diabetes were more likely than those who did not have diabetes to follow advice for losing weight and taking antihypertensive medications. However, people with diabetes were no more likely than those without diabetes to heed physicians advice to increase their physical activity.

See "Lifestyle modification to improve blood pressure control in individuals with diabetes," by Dr. Egede, in the March 2003 Diabetes Care 26(3), pp. 602-607.

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