Diabetic hypertensive control and treatment: a descriptive report from the Audit Diabetes Control and Management (ADCM) registry

  • BH Chew
  • Mastura I
  • AT Cheong
  • Syed Alwi SAR
Keywords: Diabetes mellitus, hypertension, antihypertensives, primary care, registries


Introduction: Hypertension is a common co-morbidity in diabetes mellitus (DM) that may lead to serious complications if not adequately controlled.

Method: This is a descriptive study based on data from the Audit of Diabetes Control and Management (ADCM) registry.This audit assessed the treatment and standard of control of hypertension in diabetic patients aged 18 years and above. Data were analysed using STATA version 9.

Results: From a total of 20 646 cases, about two third of them, 13 417 (65%) were reported to have hypertension. 19 484 (94.4%) had their blood pressure (BP) recorded and out of these, 11 414 (58.5%) were found to have BP >130/80 mmHg. 13 601 cases (65.9%) of the total sample were on antihypertensive drugs. 64.1% of those on antihypertensive drugs were prescribed angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers. 14.2% were on more than two types of antihypertensive drugs. Older patients and those with longer duration of DM were less likely to achieve the target BP of ≤130/80. In general, about 40% of diabetic cases registered in the ADCM project had their hypertension well controlled.


Epstein M, Sowers JR. Diabetes mellitus and hypertension. Hypertension. 1992;19(5):403-18.

Williams B. Insulin resistance; the shape of things to come. Lancet. 1994;344(8921):521-4.

Williams G. Hypertension in diabetes. In: Pickup J, Williams G, editors. Textbook of diabetes. London: Blackwell Scientific Publications; 1991. p. 719-32.

DeFronzo RA, Ferrannini E. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care. 1991;14(3):173-94.

Nishimura R, LaPorte RE, Dorman JS, et al. Mortality trends in type 1 diabetes. The Allegheny County (Pennsylvania) Registry 1965-1999. Diabetes Care. 2001;24(5):823-7.

Cowie CC, Harris MI. Physical and metabolic characteristics of patients with diabetes. In: Diabetes in America. National Diabetes Data Group. 2nd ed. Washington DC: U.S. Govt. Printing Office; 1995. p. 117-64.

Mathiesen ER, Ronn B, Jensen T, et al. Relationship between blood pressure and urinary albumin excretion in development of microalbuminuria. Diabetes. 1990:39(2):245-9.

16th Report of the Malaysian Dialysis and Transplant Registry 2008. The National Renal Registry, Malaysian Society of Nephrology, Kuala Lumpur; 2009.

Agmon Y, Khandheria BK, Meissner I, et al. Independent association of high blood pressure and aortic atherosclerosis: a population-based study. Circulation. 2000;102(17):2087-93.

Stamler J, Vaccaro O, Neaton JD, et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993;16(2):434-44.

Stratton IM, Kohner EM, Aldington SJ, et al. UKPDS 50: risk factors for incidence and progression of retinopathy in Type II diabetes over 6 years from diagnosis. Diabetologia. 2001;44(2):156-63.

Garcia MJ, McNamara PM, Gordon T, et al. Morbidity and mortality in diabetics in the Framingham population. Sixteen year follow-up study. Diabetes. 1974;23(2):105-11.

American Diabetes Association. Diabetes 2001 Vital Statistics. Alexandria VA: American Diabetes Association; 2001.

Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection,Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560-72.

Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ. 1998;317(7160):703-13.

Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet. 1998;351(9118):1755-62.

Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA. 2003;290(2):199-206.

Wolf-Maier K, Cooper RS, Kramer H, et al. Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension. 2004;43(1):10-7.

Geiss LS, Rolka DB, Engelgau MM. Elevated blood pressure among U.S. adults with diabetes, 1988-1994. Am J Prev Med. 2002;22(1):42-8.

Donnelly R, Molyneaux L, McGill M, et al. Detection and treatment of hypertension in patients with non-insulindependent diabetes mellitus: does the “rule of halves” apply to a diabetic population? Diabetes Res Clin Pract. 1997;37(1):35-40.

Berlowitz DR, Ash AS, Hickey EC, et al. Hypertension management in patients with diabetes: the need for more aggressive therapy. Diabetes Care. 2003;26(2):355-9.

American Diabetes Association. Standard of medical care in diabetes - 2006. Diabetes Care. 2006;29(Suppl 1):S4-42.

Clinical Practice Guidelines: Management of Type 2 Diabetes Mellitus, 4th ed. Ministry of Health, Malaysia; 2009.

ADCM User Manual (version 1.0) [Online].

Diabetes Malaysia Registry. About DRM-ADCM. Clinical Research Centre, Kuala Lumpur. [Online].

Economic consequences of diabetes mellitus in the U.S. in 1997. American Diabetes Association. Diabetes Care. 1998;21(2):296-309.

National Health Morbidity Survey III. Ministry of Health, Malaysia; 2006.

Noor Ghani S, Yadav H. Health Care in Malaysia. University of Malaya Press. Kuala Lumpur; 2008.

Mastura I, Zanariah H, Fatanah I, et al. An Audit of Diabetes Control and Management (ADCM). Med J Malaysia. 2008;63(suppl C):76-7.

Clinical Practice Guidelines: Management of Hypertension, 3rd ed. Ministry of Health, Malaysia; 2008.

Toh MP, Heng BH, Sum CF, et al. Measuring the quality of care of diabetic patients at the specialist outpatient clinics in public hospitals in Singapore. Ann Acad Med Singapore. 2007;36(12):980-6.

Goh PP, Elias H, Mariam I, et al. The First Annual Report of the National Eye Database 2007. [Online].

Kosachunhanun N, Benjasuratwong Y, Mongkolsomlit S, et al. Thailand diabetes registry project: glycemic control in Thai type 2 diabetes and its relation to hypoglycemic agent usage. J Med Assoc Thai. 2006;89(Suppl 1):S66-71.

Eliasson B, Cederholm J, Nilsson P, et al. The gap between guidelines and reality: Type 2 diabetes in a National Diabetes Register 1996-2003. Diabet Med. 2005;22(10):1420-6.

Bunnag P, Plengvidhya N, Deerochanawong C, et al. Thailand diabetes registry project: prevalence of hypertension, treatment and control of blood pressure in hypertensive adults with type 2 diabetes. J Med Assoc Thai. 2006;89(Suppl 1):S72-7.

Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation Study Investigators. Lancet. 2000;355(9200):253-9.

Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensinconverting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. 2000;342:145-53.

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.

Okonofua EC, Simpson KN, Jesri A, et al. Therapeutic inertia is an impediment to achieving the healthy people 2010 blood pressure control goals. Hypertension. 2006;47(3):345-51.

How to Cite
ChewB., IM., CheongA., & SARS. A. (2012). Diabetic hypertensive control and treatment: a descriptive report from the Audit Diabetes Control and Management (ADCM) registry. Malaysian Family Physician, 5(3), 5. Retrieved from https://www.e-mfp.org/ojs3/index.php/MFP/article/view/62
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