Objective To assess trends in systolic blood pressure (SBP) thresholds at initiation of antihypertensive treatment in patients with type 2 diabetes and the impact of age and frailty on these trends.
Study design and setting A repeated cross-sectional cohort study (2007–2014) using the Groningen Initiative to Analyse Type 2 diabetes Treatment database was conducted. The influence of calendar year, age or frailty and the interaction between year and age or frailty on SBP thresholds were assessed using multilevel regression analyses adjusted for potential confounders.
Results We included 4819 patients. The mean SBP at treatment initiation was 157 mm Hg in 2007, rising to 158 mm Hg in 2009 and decreasing to 151 mm Hg in 2014. This quadratic trend was significant (p<0.001). Older patients initiated treatment at higher SBP, but similar decreasing trends after 2009 were observed in all age groups. There were no significant differences in SBP thresholds between patients with different frailty groups. The association between year and SBP threshold was not influenced by age or frailty.
Conclusion After an initial rise, the observed SBP thresholds decreased over time and were not influenced by age or frailty. This is in contrast with changed guideline recommendations towards more personalised treatment during the study period and illustrates that changing prescribing practice may take considerable time. Patient-specific algorithms and tools focusing on when and when not to initiate treatment could be helpful to support personalised diabetes care.
- general diabetes
- primary care
- geriatric medicine
- protocols & guidelines
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Contributors MA contributed to the development and formulation of the research question, conducted the analysis, contributed to the interpretation of data, wrote the manuscript, reviewed and edited the manuscript, and is the guarantor of this work and, as such, takes responsibility for the integrity of the data and the accuracy of the data analysis. STdV contributed to the development and formulation of the research question, conducted the analysis, contributed to the interpretation of data and reviewed and edited the manuscript. GS contributed to the development of the analysis, the interpretation of data and reviewed and edited the manuscript. KH contributed to the development and formulation of the research question, the interpretation of data and reviewed and edited the manuscript. PD contributed to the development and formulation of the research question, development of the analysis, the interpretation of data and reviewed and edited the manuscript.
Funding This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 754425.
Disclaimer The funding source had no involvement in the study.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.
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