RT Journal Article
SR Electronic
T1 Changes in blood pressure thresholds for initiating antihypertensive medication in patients with diabetes: a repeated cross-sectional study focusing on the impact of age and frailty
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e037694
DO 10.1136/bmjopen-2020-037694
VO 10
IS 9
A1 Martina Ambrož
A1 Sieta T de Vries
A1 Grigory Sidorenkov
A1 Klaas Hoogenberg
A1 Petra Denig
YR 2020
UL http://bmjopen.bmj.com/content/10/9/e037694.abstract
AB 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.