Hypertension and Diabetes: A Lethal Combination

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This article is brought to you by a diabetes prevention partnership of the Oregon Medical Association and American Medical Association.

January 8, 2018 

Nearly 85 million people in the U.S. have high blood pressure and 84 million have prediabetes. What’s even more striking is that hypertension and diabetes often go hand in hand, which can create a lethal combination—one that significantly raises patients’ risk for heart attack or stroke. These staggering statistics and life-threatening consequences prove that prevention of both conditions is critical. 

Prevention of both high blood pressure and diabetes is also very feasible. Ensuring that patients get screened for prediabetes and have accurate blood pressure measurement done during routine clinical visits becomes a one-two punch for stemming the tide of these conditions.

Prevention is only possible, however, when it’s done properly. A recent survey found that many primary care physicians could not identify all 11 risk factors that indicate a patient qualifies for a prediabetes screening. And additional research also found that although trained in the technique, medical students could not perform all 11 steps required to achieve accurate blood pressure measurement.

Accurate Measurement is Critical

Achieving improved blood pressure control is key to managing hypertension—and saving lives—and physicians play an important role. In order to do this successfully, accurate blood pressure measurement is essential.

According to a paper published in The Journal of Clinical Hypertension, 159 medical students were tested on their knowledge of the 11 elements of BP measurement during a simulated patient encounter as part of the Blood Pressure Check Challenge. Results from the simulation revealed that the mean number of elements students performed properly was 4.1, with the average student failing to perform more than one-half of the skills properly. Only one student scored 100 percent.

Although blood pressure measurement is quite common in clinical practice, formal training in the procedure is limited to medical school for most medical students, and no retraining is offered during residency, fellowship or clinical practice for physicians to test their skill.

“Until we have a system in place where physicians are retrained at regular intervals, we have to make sure that medical students master measuring blood pressure while in school,” says Michael Rakotz, M.D., Vice President, Chronic Disease Prevention and Management at the American Medical Association.

”While it is true that other members of the clinical team take the vitals at most office visits, many physicians will confirm elevated blood pressures themselves before making a diagnosis or initiating treatment.”

Without accurate BP measurement, improving BP control does not seem likely because physicians can’t reliably identify which patients need more aggressive treatment vs. those who do not.

Physician Tools for BP Control

This highlights the need for accurate BP measurement to be taught and reinforced throughout the entire career of clinicians from medical school onward.

Fortunately, tools are available for practicing physicians, such as the Target: BP improvement program, a joint national initiative between the American Medical Association and the American Heart Association, to encourage health care practices and clinicians to prioritize blood pressure control.

The initiative supports health care organizations and teams who participate by providing them tools, resources and the latest research on sustaining BP goal rates of less than 130/80 mm Hg within their patient populations.

When medical practices and health care organizations commit to improving blood pressure control through the program and achieve high blood pressure control rates of 70 percent or higher, they become eligible to be a part of the Target: BP Recognition Program and get publicly recognized for their efforts.

Physician Tools for Diabetes Prevention

In addition to tools that help improve blood pressure control, physicians also have access to diabetes prevention resources. Some useful tools include:

  • Online prediabetes risk test, a 1-minute quiz to determine if patients have prediabetes and lifestyle tips to help lower their risk for the condition
  • Prevent Diabetes STAT, a toolkit that encourages physicians to screen, test and get patients to act to lower their risk and provides resources such as patient handouts, sample scripts for patient follow-ups and sample referral forms
  • National Diabetes Prevention Program, a Centers for Disease Control and Prevention-recognized nationwide list of in-person and online programs for patient referrals

With consistent, effective use of tools that improve blood pressure control and screen for diabetes prevention, physicians can partner with patients to reduce chronic, life-shortening health conditions and better the nation’s health. 

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