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VA study of diabetics shows overtreatment of hypertension

NEW YORK (Reuters Health) – A new study suggests veterans hospitals are following guidelines when it comes to treating diabetes and hypertension, but some diabetics with normal blood pressures may also be getting intensive blood pressure treatment that won’t do them much good.

Dr. Eve Kerr, the study’s lead author from the Department of Veterans Affairs Ann Arbor Healthcare System and the University of Michigan and colleagues examined the medical records of close to one million adult diabetics treated at VA hospitals and clinics.

Ninety-four percent of patients were either normotensive or were being treated according to guidelines.

But while under-treating blood pressure was not a big problem in the VA group, over-treatment seemed common. More than one-third of patients treated at the VA with a blood pressure below 130/65 mm Hg were on at least three blood-pressure lowering drugs, or were having their drug regimen increased. That was equal to 8% of all diabetic veterans.

Depending on the hospital, between 3% and 20% of diabetic veterans were possibly being over-treated with blood pressure medications, Dr. Kerr and her colleagues reported Monday in the Archives of Internal Medicine.

Dr. Eileen Handberg, a cardiology researcher from the University of Florida in Gainesville who wrote a commentary published with the study, told Reuters Health that guidelines don’t currently set a lower limit for recommended blood pressure in diabetic patients — and because of that, it’s hard to say doctors in this study were doing anything wrong.

Still, Dr. Handberg added, “There is a lot of conversation about, maybe lower isn’t always better.”

One limitation of the new study is that it doesn’t show whether patients were actually harmed, said Dr. Franz Messerli, director of the high blood pressure program at St. Luke’s-Roosevelt Hospital in New York.

“We don’t know whether over-treatment or under-treatment increased heart attack, stroke or death, and that’s obviously the important issue,” Dr. Messerli, who wasn’t involved in the research, told Reuters Health.

Dr. Kerr said the new study can help inform future guideline-makers about how diabetic patients are currently being treated — and how often too much blood pressure treatment might be a concern.


Arch Intern Med 2012.