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Uncontrolled BP associated with triad of comorbidities
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American Association of Clinical Endocrinologists 19th Annual Meeting
BOSTON — Patients with a triad of comorbid conditions — type 2 diabetes, hypertension and obesity — were more likely to have uncontrolled blood pressure compared with patients with type 2 diabetes only, despite antihypertensive therapy and similar glycemic control, according to results of the Study to Help Improve Early Diabetes (SHIELD) survey.
Helena W. Rodbard, MD,and colleagues presented the survey results at the American Association of Clinical Endocrinologists 19th Annual Meeting and Clinical Congress. The researchers analyzed 12-month data on glycemic control, BP, height, weight, medications and comorbid conditions. They compared respondents who reported a diagnosis of type 2 diabetes, hypertension and a BMI >30 with those who reported a diagnosis of diabetes, no hypertension and a BMI <30.
Sixty percent of respondents who reported the triad of comorbid conditions (n=593) achieved the American Diabetes Association HbA1c goal of <7% and 36% achieved the American Association of Clinical Endocrinologists goal of <6.5%. Of the respondents who had type 2 diabetes only (n=117), 69% achieved the ADA goal and 45% achieved the AACE goal (P=.10).
The researchers noted similarities in diabetes treatments and HbA1c level in both groups. Of the respondents with the triad of conditions, 70% reported taking antidiabetes therapy, 30% insulin therapy only and 39% a combination of the two. Of the respondents with type 2 diabetes only, 73% reported taking antidiabetes therapy, 33% insulin only and 56% combination therapy.
Although 92% of respondents with the triad of conditions were taking antihypertensives, 56% had systolic BP <130 mm Hg and 66% had diastolic BP <80 mm Hg; 48% of respondents with type 2 diabetes only reported taking antihypertensives, and, of those, 73% had systolic BP <130 mm Hg and 79% had diastolic BP <80 mm Hg. Sixty-three percent of respondents with the triad of comorbidities were prescribed lipid-lowering medications vs. 54% of respondents with type 2 diabetes alone (P=.001).
Only 11.5% of respondents with diabetes, hypertension and obesity had good control of their HbA1c and BP compared with 21% of patients with diabetes only (P=.004).
“There is an unmet need for effective therapeutic strategies among adults with this triad of comorbid conditions despite the availability of antihypertensive and antidiabetic treatments,” Rodbard and colleagues concluded in the study abstract.
In the obese patient with type 2 diabetes, BP goals are easier to achieve than the goals for weight or HbA1c. If enough medications are utilized, BP control is attainable in these patients. Undertreatment and noncompliance are the likely explanations for this observation.
– David S.H. Bell, MD
Endocrine Today Editorial Board member
For more information:
- Rodbard HW. Abstract #241. Presented at: American Association of Clinical Endocrinologists 19th Annual Meeting and Clinical Congress; April 21-25, 2010; Boston.
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