Hypertension Control in Ambulatory Care Patients With Diabetes

Purpose: Hypertension (HTN) control among diabetics is essential to preventing macrovascular complications. We investigated correlates of HTN control among a national sample of 1313 patients with diabetes receiving care in ambulatory care settings. Methods: The current study employed extant data from the 2008 National Ambulatory Care Survey. Multivariate logistic regression analyses were employed to examine the relationship between HTN control and candidate covariates, including race, income, provider, and facility characteristics, and patient demographic and health status indicators among patients with diabetes receiving care in ambulatory care facilities. Results: Approximately 28.7% of patients achieved HTN control at the level of 130/80 mm Hg and 57.0% at 140/90 mm Hg. Patients seen at physician offices or academic medical center/hospital settings had greater probability of HTN control compared with outpatient departments and community health centers. Patients seen in academic medical centers or other hospital settings had the greatest probability of control 147.9% at 130/80 mm Hg and 70% at 140/90 mm Hg, P<.0001). Despite being more likely lobe on antihypertensive medications, black patients with diabetes had the lowest probability of HTN control at the level of 140/90 mm Hg (41.1%) or 130/80 mm Hg (19.0%) compared with other race/ethnic groups (P<.0001). Conclusions: Patients with diabetes seen in diverse primary care settings had a low probability of having blood pressure (BP) controlled to the recommended levels. Care setting specific policies may prove useful in improving BP control. Continued attention is still warranted for racial and ethnic disparities in HTN control. (Am J Manag Care, 2012;18(1):17-23)