A Statewide Primary Care Approach to Cardiovascular Risk Factor Control in High-Risk Diabetic and Nondiabetic Patients With Hypertension

Authors

  • Jan N. Basile MD,

    1. From the Departments of Medicine1 , and Biometry and Epidemiology,2, Medical University of South Carolina, Charleston, SC; and the Ralph H. Johnson VA Medical Center, Charleston, SC3
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  • 1,3 Daniel T. Lackland DrPH,

    1. From the Departments of Medicine1 , and Biometry and Epidemiology,2, Medical University of South Carolina, Charleston, SC; and the Ralph H. Johnson VA Medical Center, Charleston, SC3
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  • 2 Jeffrey M. Basile,

    1. From the Departments of Medicine1 , and Biometry and Epidemiology,2, Medical University of South Carolina, Charleston, SC; and the Ralph H. Johnson VA Medical Center, Charleston, SC3
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  • 1 Jessica E. Riehle BS, RN,

    1. From the Departments of Medicine1 , and Biometry and Epidemiology,2, Medical University of South Carolina, Charleston, SC; and the Ralph H. Johnson VA Medical Center, Charleston, SC3
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  • and 2 Brent M. Egan MD 1

    1. From the Departments of Medicine1 , and Biometry and Epidemiology,2, Medical University of South Carolina, Charleston, SC; and the Ralph H. Johnson VA Medical Center, Charleston, SC3
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Jan N. Basile, MD, Ralph H. Johnson Medical Center, 109 Bee Street, Charleston, SC 29401-5703
E-mail: jan.basile@med.va.gov
Manuscript received May 20, 2003; revised July 18,2003; accepted July 24,2003

Abstract

Patients with multiple cardiovascular risk factors benefit from having them all controlled, but this rarely occurs. Fifty-seven primary care providers were enrolled in a program to monitor cardiovascular risk factor control. Data were obtained on 7315 hypertensives. This analysis focuses on 3460 high-risk hypertensives including 2199 with diabetes and 1261 with clinical cardiovascular disease. Blood pressures were <140/90 mm Hg and <130/80 mm Hg in only 44.3% and 20.4% of diabetics and 49.6% and 26.6% nondiabetics, respectively, despite the use of an average of 2.7±1.8 anti-hypertensive medications. Among high-risk dyslipidemic hypertensives, the low-density lipoprotein cholesterol level was <100 mg/dL in only 34% of diabetic and 33% of nondiabetic patients. Among 1696 diabetic hypertensives, the most recent glycosylated hemoglobin value averaged 7.5%, with 46.6% less than 7%. Among 805 diabetic, dyslipidemic hypertensives, all three risk factors were controlled to goal in only 6.6% with higher rates in whites than in African Americans (14.8% vs. 1.6%, p<0.001). An angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, or both were prescribed in 89.9% of diabetic and 70.8% of nondiabetic patients, p<0.05. Primary care providers use evidence-based combination therapy in high-risk hypertensive patients with and without diabetes. These findings confirm the low rates of multiple risk factor control and highlight challenges of reaching evidence-based goals in primary care.

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