Hypertensive diabetic patients in Melaka were not managed according to guidelines
Introduction: A study was conducted at primaryhealthcare level in the Melaka Tengah district ofMalaysia to determine whether hypertension inpatients with type 2 diabetes mellitus were managedaccording to guidelines.
Methods: A cross-sectional study involving 517patients with diabetes mellitus from August toOctober 2003 was performed.
Results: All the subjects had type 2 diabetesmellitus. 350 (67.7 percent) patients hadhypertension and about 25.7 percent of themwere associated with microalbuminuria. The Malayethnic group form the majority (54.6 percent),followed by Chinese (37.7 percent) and Indian(7.4 percent). Only 11 (3.1 percent) patients withtype 2 diabetes mellitus and hypertensionachieved the target blood pressure of less than130/80 mmHg. For those who had not achievedthe target goal, 39.5 percent of them werenot on any antihypertensive drugs. 38.6 percentwere on monotherapy and only 21.8 percentwere on two or more antihypertensive drugs.Metoprolol was the most commonly usedantihypertensive drug (22.4 percent), followed byNifedipine (16.2 percent) and Prazosin (13.5percent). Only 18.3 percent of patients with type2 diabetes mellitus and hypertension wereprescribed with angiotensin converting enzyme(ACE) inhibitors and 0.3 percent with angiotensinreceptor blockers. For patients with type 2 diabetesmellitus, hypertension and microalbuminuria,only 14.1 percent of them were prescribed withACE inhibitors.
Conclusion: A significant proportion of patientswith type 2 diabetes mellitus had associatedhypertension but they were not managedoptimally according to guidelines. More intensivemanagement of hypertension among patientswith diabetes is essential to reduce the morbidityand mortality at primary healthcare level.
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