Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3028 — Knowledge of Blood Pressure Targets and Blood Pressure Self-Monitoring among Patients with Diabetes

Author List:
Klamerus ML (Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System)
Hofer TP (Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System)
Zikmund-Fisher BJ (Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System)
Heisler M (Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System)
Kerr EA (Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System)

Objectives:
Tight blood pressure (BP) control is the single most important intervention to prevent cardiovascular mortality among patients with diabetes. Achieving BP control relies on effective clinical management and patient self-management. Patients who monitor BP at home are more likely to achieve BP control. We sought to understand how often patients view BP control as a priority and report having specific blood pressure targets or goals, and whether having targets is associated with BP self-monitoring. We further examined whether patient sociodemographic characteristics were associated with having BP targets.

Methods:
We conducted an anonymous survey of 500 randomly selected patients with diabetes and hypertension who used any VA facility in FY 2003. We queried patients regarding their general health care concerns, targets for BP control, and BP self-monitoring. We examined associations between having BP targets, BP self-monitoring, and patient characteristics using bivariate statistics and multivariate logistic regression.

Results:
378 (76%) patients responded, of whom 90% were taking antihypertensive medications. Of the 378, 236 (62%) reported that glycemic control was among their three most important health concerns, while 151 (40%) reported that blood pressure control was among their three most important concerns. 60% of respondents reported having a target level for BP and those with a target were more likely than those without a target to monitor their BP at home (72% vs. 35%; p<.001) and to endorse medication treatment for a BP level of 145/85 (42% vs. 29%, p=0.02). In multivariate regression, college education, but not race, age, or insulin use was positively associated with reporting a target BP (OR 2.07 [95% CI 1.3-3.4]).

Implications:
Less than half of patients with diabetes viewed BP control as a top concern, and a substantial proportion did not have target levels for BP control. Those with BP targets were more likely to self-monitor BP and to indicate that modest BP elevations should be treated. Higher education was associated with having targets.

Impacts:
Having a target BP may be an important component in promoting hypertension self-management in this high-risk patient population. Less educated patients may particularly benefit from interventions to increase awareness of BP targets.