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Clinical Decisionmaking

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Blood pressure control can be attained in a substantial number of primary care patients who have diabetes and hypertension

Many adults with diabetes also suffer from high blood pressure (hypertension), which increases their risk of cardiovascular and other diabetes-related complications. Blood pressure control plays an important part in preventing problems such as stroke and end-stage renal disease among diabetes patients. Multiple medications are generally required to achieve blood pressure control (less than 130/85 mm Hg) in these patients.

A recent article describes a case study in which one primary care practice was able to achieve blood pressure control in more than one-third (38 percent) of patients with diabetes without medications or with only one medication. The study was supported by the Agency for Healthcare Research and Quality (HS11132).

Steven M. Ornstein, M.D., of the Medical University of South Carolina, and colleagues used staff interviews and observations made during site visits to determine the primary care practice's approach to care for 469 patients with diabetes who had a blood pressure measurement during a 2001 practice visit. Fifty-three percent of the last blood pressures measured in 2001 were controlled. Of the patients who were not controlled, 44 percent had a blood pressure of less than 140/90 mm Hg, and 56 percent had a higher blood pressure.

The practice's self-described treatment approach for achieving blood pressure control was three-fold: attention to target blood pressure at each encounter, empowering patients to self-monitor with this target in mind, and primary use of angiotensin converting enzyme inhibitors. They followed medication guidelines, incorporated current guidelines and treatment goals into point-of-care templates, and involved the nursing staff in extensive case management activities, for example, to regularly contact patients who missed appointments or who were not at target blood pressure.

More details are in "Achieving blood pressure control in patients with diabetes: A case study in primary care," by Andrea M. Wessell, Pharm.D., B.C.P.S., Dr. Ornstein, Paul J. Nietert, Ph.D., and others, in the January 2003 Topics in Health Information Management 24(1), pp. 3-7.

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