Improved control of blood pressure and albuminuria among patients with type-2 diabetes in Finnish open care

<p>Risk of cardiovascular events within the diabetic population has decreased and survival increased with patients living longer and thus facing the development of end-stage renal disease (ESRD). This calls for good care of patient with diabetes with a focus on hypertension. Patient data were collected from 42 Finnish primary care centres. Each was asked to enrol 10–12 consecutive patients with type-2 diabetes between March 2011 and August 2012. Along with the office blood pressure measurements and laboratory tests, the presence of albuminuria was measured and glomerular filtration rate estimated (eGFR). The 2013 ESH criteria for diabetic hypertensive patients (<140/85 mmHg) was reached by 39% of all 625 study patients and 38% of the pharmacologically treated 520 patients. The absence of detectable albumin in urine was significantly associated with the control of systolic blood pressure and achievement of treatment goals. Beta blockers were the most common antihypertensive agents and patients treated with them had lower eGFR compared to those not treated with these agents. The blood pressure of patients was not in full concordance with the present guideline recommendations. However, satisfactory improvement in blood pressure control, reduction of albuminuria and hence ESRD prevention was achieved.</p

Impact of self-monitoring of BP on the RR of uncontrolled BP at 12 months according to level of co-intervention support (15 studies).

<p>RR of uncontrolled BP adjusted for age, sex, baseline clinic BP, and history of diabetes. The trials are grouped into the 4 levels of intervention, and <i>I</i>² and <i>P</i> values are shown for each level of intervention and for the overall analysis. The effect of self-monitoring on the RR of BP at 6 and 18 months are displayed in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002389#pmed.1002389.s012" target="_blank">S5</a> and <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002389#pmed.1002389.s015" target="_blank">S8</a> Figs, respectively. Wakefield study participants self-monitored for 6 months; follow-up continued to 12 months. Abbreviations: BP, blood pressure; RR, relative risk.</p

Impact of self-monitoring of BP on clinic and ambulatory dBP at 12 months (4 studies).

<p>These 4 studies used both clinic and ambulatory BP as endpoints and so are presented in addition to the overall results in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002389#pmed.1002389.g001" target="_blank">Fig 1</a>, which are for clinic BP alone (including these studies). Change in dBP adjusted for age, sex, baseline clinic BP, history of diabetes, and level of intervention. Effect of self-monitoring on diastolic clinic and ambulatory BP at 6 months is in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002389#pmed.1002389.s017" target="_blank">S10 Fig</a>. Abbreviations: BP, blood pressure; dBP, diastolic blood pressure.</p

Characteristics of the included studies.

<p>Characteristics of the included studies.</p

Impact of self-monitoring of BP on clinic sBP according to level of co-intervention support at 12 months (15 studies).

<p>Change in sBP adjusted for age, sex, baseline clinic BP, and history of diabetes. The trials are grouped into the 4 levels of intervention, and <i>I</i>² and <i>P</i> values are shown for each level of intervention and for the overall analysis. Effect of self-monitoring on clinic sBP at 6 and 18 months are shown in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002389#pmed.1002389.s010" target="_blank">S3</a> and <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002389#pmed.1002389.s013" target="_blank">S6</a> Figs, respectively. Wakefield’s study participants self-monitored for 6 months; follow-up continued to 12 months. Abbreviations: BP, blood pressure; sBP, systolic blood pressure.</p

Impact of self-monitoring of BP on clinic and ambulatory sBP at 12 months (4 studies).

<p>These 4 studies used both clinic and ambulatory BP as endpoints and so are presented in addition to the overall results in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002389#pmed.1002389.g001" target="_blank">Fig 1</a>, which are for clinic BP alone (including these studies). Change in sBP adjusted for age, sex, baseline clinic BP, history of diabetes, and level of intervention. Effect of self-monitoring on systolic clinic and ambulatory BP at 6 months is in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002389#pmed.1002389.s016" target="_blank">S9 Fig</a>. Abbreviations: BP, blood pressure; sBP, systolic blood pressure.</p

Impact of self-monitoring of BP on the RR of uncontrolled BP at 12 months according to prespecified subgroups (15 studies).

<p>Obesity defined as BMI ≥ 30 kg/m². RR of uncontrolled BP at 12 months adjusted for age, sex, baseline clinic BP, level of intervention, and studies contributing patient data. Abbreviations: BMI, body mass index; BP, blood pressure; CKD, chronic kidney disease; MI, myocardial infarction; RR, risk ratio; sBP, systolic blood pressure.</p