Research Activities, July 2013
Simultaneous control of diabetes, hypertension, and high cholesterol is difficult to achieve
The number of Americans living with multiple chronic conditions is growing. More than 75 million individuals have two or more chronic conditions such as diabetes, hypertension, and hyperlipidemia (high cholesterol). Patients with all three conditions struggle to control them properly, suggests a new study. It found that simultaneous control of diabetes, hypertension, and hyperlipidemia is quite uncommon. When patients are successful at controlling all three conditions, it often lasts for only a short period of time.
Researchers retrospectively studied two large groups of patients with these three chronic diseases receiving care at two health systems in Colorado from 2000 through 2008. Three primary outcomes were used to define control of each condition as recommended by the American Diabetes Association guidelines. For diabetes, it was a glycosylated hemoglobin (HbA1c) of <7.0 percent. Blood pressure had to be maintained at <130/80. The low-density lipoprotein (LDL) cholesterol had to be <100 mg/dL. Median follow-up times were 4.0 and 4.4 years for each group.
The rates of meeting any one individual risk factor goal ranged from 61 to 89 percent. Simultaneous control of all three conditions was uncommon. Only 16 percent in one group and 30 percent in the other group achieved this. Even when they did, they had a hard time maintaining it. For example, during the 90 days following achieving this triple goal, 23 percent in one group and 39 percent in the other group lost and then regained control. The rates of never losing control during this period were only 13 percent and 5 percent, respectively.
A rise in blood pressure was the most likely reason to lose control, followed by increases in HbA1c and cholesterol. When less strict goals were applied, the percentage of patients achieving simultaneous control increased to 44 percent and 70 percent in each group. The ability to achieve simultaneous control declined as the severity of conditions increased. However, as medication adherence increased, so did simultaneous control. The study was supported in part by AHRQ (HS17627).
See "Simultaneous control of diabetes mellitus, hypertension, and hyperlipidemia in 2 health systems," by Emily B. Schroeder, M.D., Ph.D., Rebecca Hanratty, M.D., Brenda L. Beaty, M.S.P.H., and others in the September 2012 Circulation Cardiovascular Quality and Outcomes 5, pp. 645-653.