Diabetics' blood pressure often inadequately controlled

NEW YORK (Reuters Health) - Uncertainty about a patient's "true" blood pressure (BP) is the chief reason why doctors fail to intensify BP-lowering treatment when a diabetic patient has high BP (hypertension), investigators report.

"Several studies have suggested that 'clinical inertia' -- the failure by providers to initiate or intensify therapy n the face of apparent need to do so -- is a main contributor to poor control of hypertension," Dr. Eve A. Kerr and colleagues explain in a report in the Annals of Internal Medicine.

To identify factors that underlie "clinical inertia," Kerr at the Veterans Affairs Ann Arbor Healthcare System in Michigan and her team studied 1,169 diabetic patients with hypertension seen by 92 primary care doctors at 9 VA facilities.

Before the study, all the patients were found to have high BP (140/90 mm Hg). Normal BP is anything below 120/80 mm/Hg.

However, despite substantially elevated BP, medication was intensified or close follow-up was scheduled for just 49 percent of the patients.

"Clinical uncertainty" about the true BP value was a prominent reason that providers did not intensify therapy, the investigators found. Specifically, they were less likely to adjust medication if they themselves recorded a BP measurement of less than 140/90 versus a higher reading during the visit, or when patients reported that their BP readings at home were less than 140/90 rather than higher.

"Unfortunately," primary care doctors are not consistent in their approach to gauging "real" BP, and are "possibly placing undue faith in their own repeated measurements or home blood pressure values," the investigators write.

"This ambiguous approach ... may be a major obstacle to optimizing management of hypertension and improving outcomes for high-risk populations," they conclude.

SOURCE: Annals of Internal Medicine, May 20, 2008.