Macrovascular
complications are common in diabetic hypertensive patients. Appropriate
antihypertensive therapy and tight blood pressure control are
believed to prevent or delay such complication.
Objective: To evaluate utilization patterns of antihypertensive
agents and blood pressure (BP) control among diabetic hypertensive
patients with and without ischemic heart disease (IHD).
Methods: Retrospective cohort study of all diabetic hypertensive
patients attending Al-watani medical center from August 2006 until
August 2007. Proportions of use of different antihypertensive
drug classes were compared for all patients receiving 1, 2, 3,
or 4 or more drugs, and separately among patients with and without
IHD. Blood pressure control (equal or lower 130/80 mmHg) was compared
for patients receiving no therapy, monotherapy, or combination
therapy and separately among patients with and without IHD.
Results: 255 patients were included in the study; their mean age
was 64.4 (SD=11.4) years. Sixty one (23.9%) of the included patients
was on target BP. Over 60% of the total patients were receiving
angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin receptor
blocker (ARB), followed by diuretics (40.8%), calcium channel
blockers (25.1%) and beta-blockers (12.5%). The majority (>
55%) of patients were either on mono or no drug therapy. More
than 55% of patients with controlled BP were using ACE-I. More
than half (50.8%) of the patients with controlled BP were on combination
therapy while 42.3% of patients with uncontrolled BP were on combination
therapy (p=0.24). More patient in the IHD achieved target BP than
those in non-IHD group (p=0.019). Comparison between IHD and non-IHD
groups indicated no significant difference in the utilization
of any drug class with ACE-I being the most commonly utilized
in both groups.
Conclusions: Patterns of antihypertensive therapy were generally
but not adequately consistent with international guidelines. Areas
of improvement include increasing ACE-I drug combinations, decreasing
the number of untreated patients, and increasing the proportion
of patients with controlled BP in this population.
