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Controlling High Blood Pressure in Patients With Diabetes

The American Diabetes Association, the American Association of College of Endocrinology, and the National Kidney Foundation™ all agree via their clinical guidelines that the use of an angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) to control high blood pressure in patients with diabetes is first-line therapy. This is due to the clinical benefit of reducing progression of renal and cardiovascular disease in these patients. The Centers for Medicare and Medicaid Services has adopted the use of an ACE inhibitor or ARB in patients with diabetes who have hypertension as a quality measure for Medicare Part D health plans. 

Despite the widely recognized benefit of this class of drugs, many of our Blue MedicareSM members who have diabetes and hypertension are still not receiving an ACE inhibitor or ARB.  The percentage of our members with diabetes who have hypertension and are receiving one of these drugs remains lower than the national average*Underuse of these medications may be due to perceptions of more side effects in the elderly, tolerance for higher than recommended blood pressures in these patients, failure to fill these prescriptions by the patients, or all of the above. 

Please reevaluate the need for an ACE inhibitor or ARB in your diabetic patients when appropriate.  Consider the recommendation to use an ACE inhibitor or ARB as part of any treatment for hypertension in patients with diabetes unless contraindicatedIf a change in therapy is necessary, advise your patient directly and send a prescription to the pharmacy.

 

*Source: 2013 Acumen Patient Safety Reports for BCBSNC and 2014 BCBSNC Star Ratings