Current status of achieving blood pressure target and its clinical correlates in Japanese type 2 diabetes (JDDM45)

AIMS/INTRODUCTION: To investigate the current status of achieved blood pressure levels in association with the number of antihypertensive drug classes as of 2013, and to explore the clinical correlates with achievement of target blood pressure in a large‐scale cohort of Japanese individuals with type 2 diabetes. MATERIALS AND METHODS: A nationwide survey was carried out including 12,811 individuals with type 2 diabetes. Participants were divided by achieved blood pressure, <130/80 or 140/90 mmHg, and the number of drug classes taken. RESULTS: The percentages achieving a blood pressure of <130/80 or 140/90 mmHg were 52.0% and 86.1%, respectively. The prevalence of hypertension, if defined as ≥130/80 mmHg or treated, became 67.9%. Among participants taking antihypertensive drugs, a blood pressure of <130/80 or <140/90 mmHg was 46.7% and 83.2%, respectively. The percentages of <130/80 mmHg were 55.9% without drugs, 47.1% on one drug, 42.5% on two drugs, 47.2% on three drugs and 56.8% on four or more drugs, respectively. The most prescribed drugs were renin–angiotensin system inhibitors, followed by calcium channel blockers, diuretics and beta‐blockers. The multiple logistic regression analysis showed that a blood pressure <130/80 mmHg was associated with lower values in age, body mass index, albuminuria and glomerular filtration rate, higher proportions on targets for glycosylated hemoglobin A1c and lipids, and less retinopathy. CONCLUSIONS: In type 2 diabetes, hypertension is common, and just 52% achieved <130/80 mmHg, indicating a difficulty in blood pressure lowering. This was correlated with difficulties in glycemic and lipid management, obesity, and vascular complications, implying this clustering to be a serious problem.