Introduction:
Blood pressure (BP) screening and control is often suboptimal in patients with diabetes, a population in whom cardiovascular disease (CVD) is the leading cause of morbidity and mortality. Hypertension in the context of diabetes uniquely increases risk for CVD incidence and mortality. The aim of this study was to describe the burden of uncontrolled BP among patients with diabetes seen in the outpatient setting and factors associated with BP control using data from a large, electronic health record (EHR) data registry.
Methods:
Outpatient EHR data were analyzed from The Guideline Advantage™ (TGA), a joint quality improvement initiative of the American Heart Association, American Diabetes Association, and American Cancer Society. Data were compiled from patients aged ≥18 years seen at >70 individual clinics across the U.S. “Uncontrolled BP” was defined as measured BP ≥140/90mmHg at the most recent outpatient visit with or without a clinical diagnosis of hypertension. Logistic regression was used to examine factors associated BP control status.
Results:
We observed 1,710,702 BP measurements among 216,947 unique patients. The population was 42% male (n= 91,062) with a mean age of 49 years; 19% (n=41,714) of patients had BP ≥140/90 mmHg at their most recent outpatient visit and 8% of the population had a history of diabetes (n= 18,242). Patients with diabetes had 1.15 times the odds of BP ≥140/90 mmHg at their most recent outpatient visit [aOR(95% CI): 1.15 (1.11-1.20)]. Among patients with a diabetes history, the following factors were associated with uncontrolled BP: race/ethnicity [(aOR: 2.81 (2.48-3.19) for non-Hispanic blacks compared to non-Hispanic whites, 1.44 (1.31-1.57) for multiracial patients versus non-Hispanic whites] , sex [aOR: 1.28 (1.25-1.31)] for males compared to females], age [aOR per 10-year increase in age: 1.22 (1.21-1.23)], and time since diabetes diagnosis [aOR per 1-year increase in time since diagnosis: 0.99(0.98-1.00)].
Conclusions:
Uncontrolled BP disproportionately impacts diabetes patients in the outpatient setting. Among these patients, BP control status differed by race/ethnicity, sex, and age. Additionally, patients were more likely to have uncontrolled BP ≥140/90 mmHg closer to the time of their diabetes diagnoses (i.e. time since diagnosis was inversely associated with BP control status). Additional investigation to identify underlying patient- and provider-level factors contributing to these observed differences will be particularly important moving forward for accountable care organizations to meet metrics for equitable quality care delivery across patient subgroups.
Factors associated with uncontrolled blood pressure among Ghanaians: Evidence from a multicenter hospital-based study
