Drug management for hypertension in type 2 diabetes in family practice

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Figure 1
Proportion of patients taking 0, 1, 2, or ≥ 3 antihypertensive medications, by age group and sex: χ²tests of association indicate significant differences by age group (P< .0001) but not sex ( P= .9); n = 527.

Table 1

Clinical data for participating patients with type 2 diabetes and hypertension*: N = 527.

CHARACTERISTIC	NO. OF PATIENTS (%)
Sex
• Male	272 (51.6)
• Female	255 (48.4)
Age, y
• < 55	97 (18.4)
• 55–64	162 (30.7)
• 65–74	130 (24.7)
• ≥ 75	138 (26.2)
Systolic BP at target (< 130 mm Hg)	175 (33.2)
Diastolic BP at target (< 80 mm Hg)	342 (64.9)
BP at target (< 130/80 mm Hg)	143 (27.1)
BMI > 30	249 (47.2)
Smoking status
• Current	57 (10.8)
• Past	201 (38.1)
• Never	232 (44.0)
• Unknown	37 (7.0)
No. of comorbidities^† and complications
• 0	13 (2.5)
• 1–3	178 (33.8)
• 4–6	221 (41.9)
• ≥ 7	115 (21.8)

BMI–body mass index, BP–blood pressure.
↵* Hypertension and type 2 diabetes considered to be the index conditions for these patients.
↵† Other morbidities were counted as comorbidities, with ischemic heart disease, dyslipidemia, metabolic syndrome, arthritis, and gastroesophageal reflux disease occurring in more than 20% of patients.

Table 2

Combinations of antihypertensive medications prescribed, from 1 to 3 drug classes: N = 419.

NO. OF DRUG CLASSES PRESCRIBED	DRUG CLASSES	NO. OF PATIENTS (%)	CI 95%
1 (n = 124)	ACEI/ARB	103 (83.1)	75.3–89.2
	Diuretic	11 (8.9)	4.5–15.3
	CCB	6 (4.8)	1.8–10.2
	BB	4 (3.2)	0.9–8.1
2 (n = 152)	ACEI/ARB + 1^*	136 (89.5)	83.5–93.9
	Diuretic + 1	94 (61.8)	53.6–69.6
	BB + 1	41 (27.0)	20.2–34.8
	CCB + 1	32 (21.1)	14.9–28.4
	Other + 1	1 (0.7)	0.0–3.6
3 (n = 143)	ACEI/ARB + 2^*	137 (95.8)	91.1–98.4
	Diuretic + 2	118 (82.5)	75.3–88.4
	BB + 2	86 (60.1)	51.6–68.2
	CCB + 2	77 (53.8)	45.3–62.2
	Other + 2	11 (7.7)	3.9–13.3

ACEI–angiotensin-converting enzyme inhibitors, ARB–angiotensin receptor blocker, BB–β-blocker, CCB–calcium channel blocker, CI–confidence interval.
↵* Meaning 1 or 2 additional classes (eg, ACEI/ARB + 1 indicates ACEI/ARB and either a diuretic, a BB, or a CCB, etc). A patient taking more than 1 drug class is counted in all relevant categories; therefore, not all percentages add up to 100.

Table 3

Dosage intensity for the 10 most commonly prescribed antihypertensive drugs

DRUG	N0. OF PATIENTS	AVERAGE DAILY DOSE, MG	UPPER LIMIT, MG	INDEX OF INTENSITY^*
Ramipril	198	9.7	10	0.97
Hydrochlorothiazide	165	19.2	25	0.77
Metoprolol	102	141.9	200	0.71
Amlodipine	88	8.1	10	0.81
Furosemide	65	55.7	80	0.70
Nifedipine	55	41.5	60	0.69
Atenolol	53	66.0	100	0.66
Lisinopril	47	23.2	40	0.58
Enalapril	47	19.5	40	0.49
Losartan	41	73.8	100	0.74

↵* Dosage intensity is calculated by dividing the average prescribed daily dose (total dose in milligrams prescribed for a single day) by the upper limit of the range of doses usually effective for hypertension according to the 2006 Compendium of Pharmaceuticals and Specialties.15