Jennifer T Fink1,2, Elizabeth M Magnan3, Heather M Johnson4, Lauren M Bednarz5,6, Glenn O Allen7, Robert T Greenlee8, Daniel M Bolt9, Maureen A Smith10,11,12. 1. Department of Health Informatics and Administration, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA. 2. Aurora Research Institute, Aurora Health Care, Milwaukee, WI, USA. 3. Department of Family and Community Medicine, University of California, Davis, Sacramento, CA, USA. 4. Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 5. Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Dr., Suite 210-31, Madison, WI, 53705, USA. 6. Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 7. Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 8. Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA. 9. Department of Educational Psychology, University of Wisconsin School of Education, Madison, WI, USA. 10. Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Dr., Suite 210-31, Madison, WI, 53705, USA. maureensmith@wisc.edu. 11. Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. maureensmith@wisc.edu. 12. Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. maureensmith@wisc.edu.
Abstract
INTRODUCTION: There are no population-level estimates in the United States for achievement of blood pressure goals in patients with diabetes and hypertension by obesity weight class. AIM: We sought to examine the relationship between the extent of obesity and the achievement of guideline-recommended blood pressure goals and other quality of care metrics among patients with diabetes. METHODS: We conducted an observational population-based cohort study of electronic health data of three large health systems from 2010-2012 in rural, urban and suburban settings of 51,229 adults with diabetes. Outcomes were achievement of diabetes quality of care metrics: blood pressure, A1c, and LDL control, and A1c and LDL testing. Two blood pressure goals were examined given the recommendation for adults with diabetes of 130/80 mmHg from JNC7 and the recommendation of 140/90 mmHg from JNC8 in 2014. RESULTS: Patients in obesity classes I, II, and III with diagnosed hypertension were less likely to achieve blood pressure control at both the 140/90 mmHg and 130/80 mmHg control levels. The patients from obesity class III had the lowest likelihood of achieving control at the 130/80 mmHg goal, and control was markedly worse for the 130/80 mmHg threshold in all weight classes. There were minimal to no differences by weight class in LDL and A1c control and LDL and A1c testing. CONCLUSIONS: Although the cardiovascular risk for patients with obesity and diabetes is greater than for non-obese patients with diabetes, we found that patients with obesity are even further behind in achieving blood pressure control.
INTRODUCTION: There are no population-level estimates in the United States for achievement of blood pressure goals in patients with diabetes and hypertension by obesity weight class. AIM: We sought to examine the relationship between the extent of obesity and the achievement of guideline-recommended blood pressure goals and other quality of care metrics among patients with diabetes. METHODS: We conducted an observational population-based cohort study of electronic health data of three large health systems from 2010-2012 in rural, urban and suburban settings of 51,229 adults with diabetes. Outcomes were achievement of diabetes quality of care metrics: blood pressure, A1c, and LDL control, and A1c and LDL testing. Two blood pressure goals were examined given the recommendation for adults with diabetes of 130/80 mmHg from JNC7 and the recommendation of 140/90 mmHg from JNC8 in 2014. RESULTS:Patients in obesity classes I, II, and III with diagnosed hypertension were less likely to achieve blood pressure control at both the 140/90 mmHg and 130/80 mmHg control levels. The patients from obesity class III had the lowest likelihood of achieving control at the 130/80 mmHg goal, and control was markedly worse for the 130/80 mmHg threshold in all weight classes. There were minimal to no differences by weight class in LDL and A1c control and LDL and A1c testing. CONCLUSIONS: Although the cardiovascular risk for patients with obesity and diabetes is greater than for non-obesepatients with diabetes, we found that patients with obesity are even further behind in achieving blood pressure control.
Authors: John M Flack; Roman Casciano; Julian Casciano; James Doyle; Steven Arikian; Simon Tang; Raul Arocho Journal: Manag Care Interface Date: 2002-11
Authors: Edward W Gregg; Yiling J Cheng; Betsy L Cadwell; Giuseppina Imperatore; Desmond E Williams; Katherine M Flegal; K M Venkat Narayan; David F Williamson Journal: JAMA Date: 2005-04-20 Impact factor: 56.272
Authors: Peter Bramlage; David Pittrow; Hans-Ulrich Wittchen; Wilhelm Kirch; Steffen Boehler; Hendrik Lehnert; Michael Hoefler; Thomas Unger; Arya M Sharma Journal: Am J Hypertens Date: 2004-10 Impact factor: 2.689
Authors: Aram V Chobanian; George L Bakris; Henry R Black; William C Cushman; Lee A Green; Joseph L Izzo; Daniel W Jones; Barry J Materson; Suzanne Oparil; Jackson T Wright; Edward J Roccella Journal: Hypertension Date: 2003-12-01 Impact factor: 10.190
Authors: Alain G Bertoni; Jeanne M Clark; Patricia Feeney; Susan Z Yanovski; John Bantle; Brenda Montgomery; Monika M Safford; William H Herman; Steven Haffner Journal: J Diabetes Complications Date: 2008 Jan-Feb Impact factor: 2.852
Authors: Jan A Staessen; Elly Den Hond; Hilde Celis; Robert Fagard; Louis Keary; Guy Vandenhoven; Eoin T O'Brien Journal: JAMA Date: 2004-02-25 Impact factor: 56.272
Authors: Jun Jie Benjamin Seng; Amelia Yuting Monteiro; Yu Heng Kwan; Sueziani Binte Zainudin; Chuen Seng Tan; Julian Thumboo; Lian Leng Low Journal: BMC Med Res Methodol Date: 2021-03-11 Impact factor: 4.615