ABSTRACTS
HYPERTENSIVE DIABETIC PATIENTS IN MELAKA WERE NOT MANAGED ACCORDING TO GUIDELINES
Chan GC. Type 2 diabetes mellitus with hypertension at primary healthcare level in Malaysia: are they managed according to guidelines? Singapore Med J. 2005;46(3):127-31 [PubMed] [Full text]Hypertension is an extremely common co-morbid condition in diabetes, affecting about 20-60% of patients with diabetes. Control of hypertension is dramatically effective in reducing cardiovascular events and mortality. The availability of clinical practice guidelines (CPG) raises an important question: are these guidelines being followed by the primary care doctors? This is a matter of great interest and importance and addressed in this cross sectional study involving 517 type 2 diabetes at primary healthcare level in Melaka Tengah district. About 62% of them were female with mean age of 59 and mean duration of diabetes of 7.1 years.
Two-thirds of these diabetic patients had hypertension (26% of them had microalbuminuria). Only 11 of them (3.1%) achieved target blood pressure of less than 130/80 mmHg. For those who had not achieved target goal, about 39.5% of them were not on any antihypertensive drugs; 38.6% were on monotherapy and only 21.8% were on two or more antihypertensive drugs. Only 18.3% of them were prescribed with angiotensin-converting enzyme inhibitors (ACEI) and 0.3% with angiotensin receptor blockers (ARBs). Among those hypertensive diabetics with microalbuminuria, only 14.1% of them were prescribed with ACE inhibitors.
This study showed that a significant proportion of diabetic patients were associated with hypertension but they were not managed optimally according to the guidelines. This could be due to the primary care doctors did not follow the guidelines strictly in managing diabetes. The poor adherence may be due to lack of awareness about guidelines. In addition, some doctors perhaps aware of CPG but do not implement acquired knowledge into their everyday practice. Therefore, remedial measures should be taken such as promotion and adoption of practice guidelines in primary care doctors’ everyday practice as well as improvement of comprehensive programme on hypertension management.
Reprint request: Dr. Chan Giin Cherng. Klinik Cheng, No 20, Jalan CB-1, Taman Cheng Baru, 75250 Melaka. Email: dr_changc@yahoo.com