Abstract 4153: Physician Utilization of Blood Pressure Standards for the Inpatient Diabetes Population
BACKGROUND The seventh report of the Joint National Committee (JNC 7) and the American Diabetes Association (ADA) position statement both recommend a target blood pressure of less than 130/80 mmHg in patients with diabetes. Initial therapy should include either an ACE Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB). Evaluation of guideline adherence in diabetes inpatients is limited. A retrospective review to examine this practice was performed.
METHODS The sample included hospitalized patients with a secondary diagnosis of diabetes admitted during February, March and April of 2003 and 2004. Patients with known cardiovascular or peripheral vascular disease were excluded. A manual chart audit was performed. Data collected identified those patients at blood pressure goal. Blood pressure and ACEI/ARB therapy was then collected at admission, during hospitalization and again at discharge. Evaluations of all variables were performed for the total diabetes population and each gender.
RESULTS 1766 patients were included in the review (836 in 2003, 930 in 2004). At discharge, a combined 793 (44.9%) met national blood pressure goals. Similar extrapolations were preformed for each year and gender. There appears to be no difference between years 2003 and 2004, and between genders (see Table 1⇓).
CONCLUSION Despite widespread promotion of the guidelines in 2003 and 2004, compliance remains low in hospitalized patient with diabetes excluding those with known cardiovascular and peripheral vascular disease. This analysis demonstrates the difficulty implementing national guidelines for blood pressure management in the hospitalized patient with diabetes. Outpatient studies have had similar compliance rates. Increased physician awareness of national guidelines for standard of care is necessary to improve patient care. New approaches should be considered to prompt physician compliance to these national guidelines for standard of care in this patient population.