Characteristics and blood pressure management in patients with and without diabetes in primary care in rural Victoria

Aims/hypothesis: This study tested whether diabetic hypertensive patients receive more intensive BP management than hypertensive patients without diabetes. Methods: A 12 month retrospective review of BP management was undertaken among 2460 hypertensive patients (335 with diabetes), aged 40-79 years from randomly selected general practices in rural Australia. Results: Prevalent diagnosed cardiovascular disease (CVD) was commoner among diabetic than non-diabetic patients (27.2% vs. 16.0%, OR 1.82 (1.39-2.39)). The proportion with a BP < 130/80 mm Hg was low (22.9% vs. 18.6%, p = .069, respectively). BP was monitored more closely among diabetic patients (e.g. quarterly BP measurements in 18.2% vs. 10.5% respectively, p < .001), was treated with more anti-hypertensive agents (1.5 ± 1.0 vs. 1.0 ± 1.0, p < 001) and was more likely to be associated with other CVD medications. Achievement of non-diabetic BP targets was associated with living in the regional centre (vs. smaller rural town: 1.21 (1.02-1.43)) and CVD (1.54 (1.21-1.95)), but not the presence of diabetes (0.94 (0.73-1.19)). Conclusions: In this population, hypertension is more aggressively monitored and treated among diabetic than non-diabetic patients, but largely due to their CVD and not to the level recommended in guidelines. Commencing anti-hypertensive treatment earlier (e.g. at diagnosis) and recommending more agents (e.g. in combination) may be needed to improve BP control among diabetic patients on a population basis.