Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3075 — Prevalence of Inadequate Hypertension Control among Diabetics after a Major Cardiovascular Event

Roumie CL (Tennessee Valley Healthcare, GRECC, Center for Patient Healthcare Behavior;Clinical Research Center of Excellence; Department of Medicine, Vanderbilt ) , Greevy R (Tennessee Valley Healthcare, GRECC, Center for Patient Healthcare Behavior, Clinical Research Center of Excellence; Dept of Biostatistics, Vanderbilt), Maney M (VA New Jersey Healthcare System), Findley TW (VA New Jersey Healthcare System and University of Medicine and Dentistry of New Jersey)

Elevated blood pressure (BP) is a known contributor to diabetic macrovascular complications such as stroke and myocardial infarction (MI), and reductions in BP can decrease the risk of recurrent events. Our aim was to describe the quality of hypertension care among diabetic patients after 2 common cardiovascular events, stroke and MI.

We conducted a retrospective cohort study utilizing the Diabetes Epidemiology Cohort (DEpiC), a longitudinal database of over 500,000 veterans with diabetes. The population included veterans hospitalized for an initial stroke (Reker specific) or MI (ICD 9-CM 410.X, or 411.1 and length of stay > 3 days) between 1998 and 2000. We excluded patients who had < 1 pre and/or post event BP, had both stroke and MI, or died in the year following their cardiovascular event. We examined recorded BP and hypertension medication regimens for 1 year after their discharge date. The outcome was the proportion of patients in each group that had adequate BP control (= 130/85 according to JNC-6 guidelines which were applicable in this time period).

We identified 343 veterans with a stroke and 1689 veterans with an MI who were hospitalized for an initial cardiovascular event and met our inclusion criteria. Stroke patients were older than MI patients (66.9 years vs. 65.6 years p=0.02) and most were male (98.6% vs. 98.6%). Stroke patients were more likely African American compared to patients with MI (22.2% vs. 12.2% p<0.0001). The baseline diastolic BP was higher among those hospitalized with stroke compared to MI (141.8/76.3 mm/Hg vs. 141.3/74.5 p=0.71 systolic, p=0.018 diastolic). In the year after hospitalization for their cardiovascular event, the average BP among stroke patients decreased to 136.8/72.2 vs. 132.7/69.8 among MI patients (p=0.002 systolic, p=0.001 diastolic). Stroke patients were less likely to have their last BP in control (SBP<130 & DBP<85 mm Hg) (35.9% vs. 41.9% p=0.039). Post cardiovascular event, fewer stroke patients were on at least 2 antihypertensive medications than MI patients (29.7% vs. 42.1% p<0.001).

BP values in excess of national guidelines are common after both stroke and MI; however fewer stroke patients achieved BP control. Fewer patients who had a stroke were prescribed 2 antihypertensive agents despite the higher average BP in this group.

Efforts to increase BP control after a hospitalization for an event will enhance secondary prevention of cardiovascular diseases and improve the quality of care provided to veterans.