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Lack of Effect of Guideline Changes on Hypertension Control for Patients With Diabetes in the U.S., 1995–2005

Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania; and the Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania

Address correspondence and reprint requests to Y. Richard Wang, MD, PhD, Medicine Administration, Rm. 812, 8th Floor PP, Temple University Hospital, 3401 N. Broad St., Philadelphia, PA 19140. E-mail: yize.wang{at}tuhs.temple.edu

OBJECTIVE—To study the effect of new Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) guidelines on hypertension control for patients with diabetes in the U.S. using patients without diabetes as the control group for the time trend.

RESEARCH DESIGN AND METHODS—The JNC VI and VII guidelines, published in 1997 and 2003, set more aggressive goal blood pressure for patients with diabetes. Data from the National Disease and Therapeutic Index, a nationally representative survey of outpatient visits in the U.S., was used to compare the difference in hypertension control (blood pressure <140/90 mmHg) between diabetic and nondiabetic visits during 1995–2005.

RESULTS—Hypertension control improved for both diabetic and nondiabetic visits in the study period. Compared with nondiabetic visits, there was no change in hypertension control for diabetic visits before 2001 and an 4% increase afterward (P < 0.001).

CONCLUSIONS—The publication of new JNC guidelines did not result in substantially better hypertension control for patients with diabetes in the U.S.

Abbreviations: JNC, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure • NDTI, National Disease and Therapeutic Index

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