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Blood Pressure Control and Other Quality of Care Metrics for Patients with Obesity and Diabetes: A Population-Based Cohort Study

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Abstract

Introduction

There are no population-level estimates in the United States for achievement of blood pressure goals in patients with diabetes and hypertension by obesity weight class.

Aim

We sought to examine the relationship between the extent of obesity and the achievement of guideline-recommended blood pressure goals and other quality of care metrics among patients with diabetes.

Methods

We conducted an observational population-based cohort study of electronic health data of three large health systems from 2010–2012 in rural, urban and suburban settings of 51,229 adults with diabetes. Outcomes were achievement of diabetes quality of care metrics: blood pressure, A1c, and LDL control, and A1c and LDL testing. Two blood pressure goals were examined given the recommendation for adults with diabetes of 130/80 mmHg from JNC7 and the recommendation of 140/90 mmHg from JNC8 in 2014.

Results

Patients in obesity classes I, II, and III with diagnosed hypertension were less likely to achieve blood pressure control at both the 140/90 mmHg and 130/80 mmHg control levels. The patients from obesity class III had the lowest likelihood of achieving control at the 130/80 mmHg goal, and control was markedly worse for the 130/80 mmHg threshold in all weight classes. There were minimal to no differences by weight class in LDL and A1c control and LDL and A1c testing.

Conclusions

Although the cardiovascular risk for patients with obesity and diabetes is greater than for non-obese patients with diabetes, we found that patients with obesity are even further behind in achieving blood pressure control.

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Author information

Authors and Affiliations

  1. Department of Health Informatics and Administration, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA

    Jennifer T. Fink

  2. Aurora Research Institute, Aurora Health Care, Milwaukee, WI, USA

    Jennifer T. Fink

  3. Department of Family and Community Medicine, University of California, Davis, Sacramento, CA, USA

    Elizabeth M. Magnan

  4. Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Heather M. Johnson

  5. Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Dr., Suite 210-31, Madison, WI, 53705, USA

    Lauren M. Bednarz & Maureen A. Smith

  6. Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Lauren M. Bednarz & Maureen A. Smith

  7. Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Glenn O. Allen

  8. Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA

    Robert T. Greenlee

  9. Department of Educational Psychology, University of Wisconsin School of Education, Madison, WI, USA

    Daniel M. Bolt

  10. Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Maureen A. Smith

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  1. Jennifer T. Fink
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  2. Elizabeth M. Magnan
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Corresponding author

Correspondence to Maureen A. Smith.

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Funding

This study was funded by Grant R21 HS021899 from the Agency for Healthcare Research and Quality. Additional support was provided by the Health Innovation Program, the University of Wisconsin School of Medicine and Public Health from The Wisconsin Partnership Program, and the Community-Academic Partnerships core of the University of Wisconsin Institute for Clinical and Translational Research (UW ICTR) through the National Center for Advancing Translational Sciences (NCATS), Grant UL1TR000427. Dr. Magnan was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR000002 and linked award KL2TR001859. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Fink, J.T., Magnan, E.M., Johnson, H.M. et al. Blood Pressure Control and Other Quality of Care Metrics for Patients with Obesity and Diabetes: A Population-Based Cohort Study. High Blood Press Cardiovasc Prev 25, 391–399 (2018). https://doi.org/10.1007/s40292-018-0284-x

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