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Blood Pressure Goal Attainment According to JNC 7 Guidelines and Utilization of Antihypertensive Drug Therapy in MCO Patients With Type 1 or Type 2 Diabetes

OBJECTIVES: Controlling hypertension (HTN) in patients with diabetes mellitus (DM) can reduce complications such as nephropathy, cerebrovascular disease, and cardiovascular disease. As part of a quality improvement project with a managed care organization (MCO), we evaluated blood pressure (BP) cont...

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Autores principales: Andros, Vickie, Egger, Allison
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Academy of Managed Care Pharmacy 2006
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10437310/
https://www.ncbi.nlm.nih.gov/pubmed/16792436
http://dx.doi.org/10.18553/jmcp.2006.12.4.303
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author Andros, Vickie
Egger, Allison
author_facet Andros, Vickie
Egger, Allison
author_sort Andros, Vickie
collection PubMed
description OBJECTIVES: Controlling hypertension (HTN) in patients with diabetes mellitus (DM) can reduce complications such as nephropathy, cerebrovascular disease, and cardiovascular disease. As part of a quality improvement project with a managed care organization (MCO), we evaluated blood pressure (BP) control relative to the type of drug therapy for patients with type 1 or type 2 DM who were identified from pharmacy claims for antihyperglycemic drug therapy. METHODS: Pharmacy claims for antihyperglycemic drugs, including insulin, were used to identify a random sample of commercial members in an MCO comprising 30 health plans across the United States. Retrospective medical record review was conducted in October 2003 to collect data from 4,814 patient charts. BP goal attainment according to The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines was determined for each patient from the most recent BP reading documented in the medical chart. RESULTS: The distribution by type of DM was 21.0% (n=1,011) for type 1, 75.7% (n = 3,644) for type 2, and 3.3% (n = 159) for cases not documented in the medical chart. Excluding 590 charts (12.3%) without BP values, there were 1,328 of 4,224 DM patients (31.4%) at JNC 7 BP goal (less than130/80 mm Hg). Of the 1,328 patients at JNC 7 BP goal, 577 (43.4%) were at JNC 7 BP goal with no drug therapy. Excluding the 577 patients who did not require drug therapy to reach JNC 7 goal, 751 (20.6%) of the remaining 3,647 patients who required antihypertensive drug therapy were at JNC 7 BP goal, and 788 (21.6%) received no antihypertensive drug therapy. For the population of 4,224 DM patients with a BP value recorded in the chart, application of the lower BP goals in the JNC 7 guidelines reduced the proportion with controlled BP to 31.4% (1,328/4,224) from 42.6% (1,799/4,224) according to the former JNC 6 guidelines (P less than0.01). The proportion of DM patients with HTN was 59.6% (n=2,870), and 28.4% (n=814) of these patients were not taking either an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB). There were 704 patients with albuminuria or nephropathy (14.6%), of which 35.4% (n = 249) were not taking either an ACEI or an ARB, preferred therapy in these patients. CONCLUSIONS: In this population of MCO members with DM for whom a BP value was recorded in the medical chart, 13.7% met JNC 7 BP goal with no antihypertensive drug therapy. For the patients with DM who received antihypertensive drug therapy and had a BP value recorded in the medical chart, only 26.3% were at JNC 7 BP goal. The application of JNC 7 guidelines significantly reduced the proportion of DM patients at target BP goal from 42.6%% to 31.4%
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spelling pubmed-104373102023-08-21 Blood Pressure Goal Attainment According to JNC 7 Guidelines and Utilization of Antihypertensive Drug Therapy in MCO Patients With Type 1 or Type 2 Diabetes Andros, Vickie Egger, Allison J Manag Care Pharm Research OBJECTIVES: Controlling hypertension (HTN) in patients with diabetes mellitus (DM) can reduce complications such as nephropathy, cerebrovascular disease, and cardiovascular disease. As part of a quality improvement project with a managed care organization (MCO), we evaluated blood pressure (BP) control relative to the type of drug therapy for patients with type 1 or type 2 DM who were identified from pharmacy claims for antihyperglycemic drug therapy. METHODS: Pharmacy claims for antihyperglycemic drugs, including insulin, were used to identify a random sample of commercial members in an MCO comprising 30 health plans across the United States. Retrospective medical record review was conducted in October 2003 to collect data from 4,814 patient charts. BP goal attainment according to The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines was determined for each patient from the most recent BP reading documented in the medical chart. RESULTS: The distribution by type of DM was 21.0% (n=1,011) for type 1, 75.7% (n = 3,644) for type 2, and 3.3% (n = 159) for cases not documented in the medical chart. Excluding 590 charts (12.3%) without BP values, there were 1,328 of 4,224 DM patients (31.4%) at JNC 7 BP goal (less than130/80 mm Hg). Of the 1,328 patients at JNC 7 BP goal, 577 (43.4%) were at JNC 7 BP goal with no drug therapy. Excluding the 577 patients who did not require drug therapy to reach JNC 7 goal, 751 (20.6%) of the remaining 3,647 patients who required antihypertensive drug therapy were at JNC 7 BP goal, and 788 (21.6%) received no antihypertensive drug therapy. For the population of 4,224 DM patients with a BP value recorded in the chart, application of the lower BP goals in the JNC 7 guidelines reduced the proportion with controlled BP to 31.4% (1,328/4,224) from 42.6% (1,799/4,224) according to the former JNC 6 guidelines (P less than0.01). The proportion of DM patients with HTN was 59.6% (n=2,870), and 28.4% (n=814) of these patients were not taking either an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB). There were 704 patients with albuminuria or nephropathy (14.6%), of which 35.4% (n = 249) were not taking either an ACEI or an ARB, preferred therapy in these patients. CONCLUSIONS: In this population of MCO members with DM for whom a BP value was recorded in the medical chart, 13.7% met JNC 7 BP goal with no antihypertensive drug therapy. For the patients with DM who received antihypertensive drug therapy and had a BP value recorded in the medical chart, only 26.3% were at JNC 7 BP goal. The application of JNC 7 guidelines significantly reduced the proportion of DM patients at target BP goal from 42.6%% to 31.4% Academy of Managed Care Pharmacy 2006-05 /pmc/articles/PMC10437310/ /pubmed/16792436 http://dx.doi.org/10.18553/jmcp.2006.12.4.303 Text en Copyright © 2006, Academy of Managed Care Pharmacy. All rights reserved. https://creativecommons.org/licenses/by/4.0/This article is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use and redistribution provided that the original author and source are credited.
spellingShingle Research
Andros, Vickie
Egger, Allison
Blood Pressure Goal Attainment According to JNC 7 Guidelines and Utilization of Antihypertensive Drug Therapy in MCO Patients With Type 1 or Type 2 Diabetes
title Blood Pressure Goal Attainment According to JNC 7 Guidelines and Utilization of Antihypertensive Drug Therapy in MCO Patients With Type 1 or Type 2 Diabetes
title_full Blood Pressure Goal Attainment According to JNC 7 Guidelines and Utilization of Antihypertensive Drug Therapy in MCO Patients With Type 1 or Type 2 Diabetes
title_fullStr Blood Pressure Goal Attainment According to JNC 7 Guidelines and Utilization of Antihypertensive Drug Therapy in MCO Patients With Type 1 or Type 2 Diabetes
title_full_unstemmed Blood Pressure Goal Attainment According to JNC 7 Guidelines and Utilization of Antihypertensive Drug Therapy in MCO Patients With Type 1 or Type 2 Diabetes
title_short Blood Pressure Goal Attainment According to JNC 7 Guidelines and Utilization of Antihypertensive Drug Therapy in MCO Patients With Type 1 or Type 2 Diabetes
title_sort blood pressure goal attainment according to jnc 7 guidelines and utilization of antihypertensive drug therapy in mco patients with type 1 or type 2 diabetes
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10437310/
https://www.ncbi.nlm.nih.gov/pubmed/16792436
http://dx.doi.org/10.18553/jmcp.2006.12.4.303
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