Frequent GP visits reduce diabetics blood pressure faster

[kkmalaysia]

Frequent visits to the GP lowered the blood pressure (BP) of diabetes patients more quickly, according to a study published in Hypertension.

High BP is a major risk factor for macro and microvascular complications in diabetics, but patients are not meeting evidence-based treatment goals even though the advantages of BP reduction are well-documented, researchers wrote.

“Both the physicians and the patients with elevated blood pressure should take steps towards more frequent communication – whether face-to-face or otherwise,” said lead author of the study Dr. Alexander Turchin, assistant professor of medicine at Harvard Medical School and director of Informatics Research at the Division of Endocrinology at the Brigham and Women’s Hospital in Boston, Massachusetts, US.

Guidelines from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure propose that hypertensive individuals be re-evaluated in less than 1 month, but in practice, the waits between doctor-patient appointments are longer, researchers noted.

They added that the disparity between the guidelines and actual medical practice could be a contributing factor for the poor outcomes in patients with high BP.

Investigators, therefore, conducted a retrospective cohort study of about 5,000 hypertensive diabetics to look at whether a shorter interval between diabetes patients’ visits to the GP would improve BP control. [Hypertension 2010, DOI: 10.1161/HYPERTENSIONAHA.109.148791]

Patients who saw their GPs at intervals of a month or less had their BP decrease to normal after an average of 1.5 months, at a rate of 28.7 mmHg per month. Those who saw their GPs at intervals of more than a month had their BP normalize after slightly over a year at a rate of 2.6 mmHg per month.

The greatest BP improvement was seen in patients who met their GPs every 2 weeks or less. Patients’ BP normalized in an average of 0.7 months when the break between their visits was 2 weeks or less, and in an average of 1.9 months when the break was 2 weeks to 1 month.

“Shorter encounter intervals may be difficult to implement in practice,” wrote Turchin and colleagues, pointing out that the increasing shortage of primary care physicians meant that they were already being stretched.

More creative approaches are needed to make shorter encounter intervals a possibility, they stated. “Not all of the encounters need to be face-to-face visits by individual patients: some could be group visits or telephone or email communications.

“Mid-level providers could take over algorithm-based medication titration to relieve the time pressure on the physicians, an approach known to be effective in a number of studies, even while the intervals between physician visits increased.”

Source: mims.com