TUESDAY, May 20 (HealthDay News) -- Diabetic patients with high blood pressure are less likely to receive treatment changes if their provider is unsure about their true blood pressure, according to a review in the May 20 issue of the Annals of Internal Medicine.
Eve A. Kerr, M.D., from the University of Michigan in Ann Arbor, and colleagues examined whether elevated blood pressure (140/90 mm Hg or more) during routine primary care visits led to treatment changes, and assessed factors affecting treatment changes, in 1,169 diabetics seen at Veterans Affairs facilities.
The researchers found that 49 percent of patients had a treatment change. Treatment changes were significantly less likely if the provider had repeatedly recorded a lower blood pressure or had no recorded repeated blood pressure (13 versus 61 percent), if the patient reported a lower home blood pressure or had no recorded home blood pressure (18 versus 52 percent), if the provider had a systolic treatment goal greater than 130 mm Hg versus 130 mm Hg or less (33 versus 52 percent), if conditions unrelated to diabetes or hypertension were discussed (44 versus 55 percent), and if medication issues were discussed (23 versus 52 percent).
"Providers often act as if they don't need to respond to a systolic blood pressure above goal if it has been lower in the past, is lower at home, is only slightly elevated, or is lower on a repeated measurement -- in other words, if it's not clear that the patient's usual blood pressure is high and that a provider needs to take action," Lawrence S. Phillips, M.D., and Jennifer G. Twombly, M.D., Ph.D., from Emory University in Atlanta, write in an accompanying editorial. "It's time to overcome clinical inertia."
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