Diabetes and High Blood Pressure   (May 20, 2008)

A newly published study, The Role of Clinical Uncertainty in Treatment Decisions for Diabetic Patients with Uncontrolled Blood Pressure, points out that people with diabetes and hypertension (AKA high blood pressure or HBP) often see their physicians, have high BP readings, yet don't have their HBP treatment adjusted.

The authors give examples of why physicians procrastinate, ranging from the obvious (the patient showed up at the clinic for another problem that took priority) to the seemingly bizarre (if more than one reading was obtained, which blood pressure value or which combination of values would best represent a patient's true blood pressure).

Perhaps of some concern is that the authors only investigated the behavior of primary care Veteran's Administration physicians; whether the behaviors of private-practice physicians, specialists, or Nurse Practitioners or Physician Assistants would be different can only be speculated. It might well be worse in other settings, or better in some. For example, diabetes specialists might be more aware of the risks of hypertension, and more aggressive in their management; NPs and Pas might be working under treatment protocols that clearly spell out when to escalate hypertension therapy. Perhaps somebody will pick up the ball and study the behavior of these other healthcare professionals.

Although one can quibble about the study design, the main concern I have is shared by the authors: the number of patients with inadequate blood pressure control remains high and contributes to excess morbidity and mortality, especially among patients at high risk from the complications of hypertension.

My recommendation: if you have diabetes, and your BP reading is 140/90 or higher (which is higher than the values usually advised for people with diabetes!), you almost always should have your antihypertensive medications adjusted. If your physician declines to do so, ask why. And gently encourage him/her to make a change.

After all, it's your life that's at stake.