Improved control of blood pressure and albuminuria among patients with type-2 diabetes in Finnish open care

Figures & data

Table 1. Clinical characteristics of the study patients.

	Females N = 291	Males N = 334	All N = 625
Age (years)	67 (11; 29–90)	66 (10; 35–92)	67 (10; 29–92)
BMI (kg/m^2)	33.5 (6.8; 19.2–70.7)	32.2 (6.3; 17.7–59.2)	32.8 (6.5; 17.7–70.7)
Smoking
non-smokers	243 (83.5)	178 (53.3)	421 (67.4)
Smokers	21 (7.2)	45 (13.5)	66 (10.6)
Ex-smokers	27 (9.3)	111 (33.2)	138 (22.1)
History of dyslipidaemia	219 (75.3)	239 (71.6)	458 (73.3)
History of hypertension	239 (82.1)	278 (83.2)	517 (82.7)
History of MCC	49 (16.8)	89 (26.6)	138 (22.1)
Time since T2D diagnosis (yrs)^a	8.3 (4.2–15.6)	9.3 (5.0–14.7)	9.2 (4.4–15.3)
≥ 10 years	123 (42.3)	135 (40.4)	258 (41.3)
LDL cholesterol <2.5 mmol/l^b	148 (54.8)	194 (59.9)	342 (57.6)
HbA1C (%)^a	6.9 (6.3–7.7)	6.8 (6.3–7.8)	6.9 (6.3–7.8)
< 7.0%	154 (52.9)	183 (54.8)	337 (53.9)
7.0–8.5%	92 (31.6)	97 (29.0)	189 (30.2)
> 8.5%	45 (15.5)	54 (16.2)	99 (15.8)
Albuminuria	50 (17.2)	102 (30.5)	152 (24.3)
Abnormal eGFR <90 ml/min/1.73m^2	191 (65.6)	185 (55.4)	376 (60.2)
CKD (grade 1–5)	207 (71.1)	222 (66.5)	429 (68.6)
Use of medications:
Statins	184 (63.2)	207 (62.0)	391 (62.6)
ASA	147 (50.5)	196 (58.7)	343 (54.9)

Results are given as mean (SD, range) or number (%) of patients.

^a Median (inter-quartile range).

^b N = 270 for female and n = 324 for male patients.

CKD: chronic kidney disease; MCC: coronary artery disease.

Table 2. Office blood pressure, achievement of different blood pressure targets and usage of antihypertensive medications in patients with diabetes.

Patients who were treated with antihypertensive medication:	Females N = 242	Males N = 278	All N = 520	p^e
Blood pressure SBP (mmHg)	142 (17; 104–220)	143 (18; 100–194)	142 (18; 100–220)	0.35
DBP (mmHg)	80 (11; 53–112)	81^d (10; 55–113)	80 (11; 53–113)	0.26
BP targets
<130/80 mmHg^a	40 (16.5)	41 (14.8)	81 (15.6)	0.59
<140/85 mmHg^b	105 (43.4)	92 (33.2)	197 (38.0)	0.02
<140/90 mmHg^c	115 (47.5)	109 (39.4)	224 (43.2)	0.06
Antihypertensive medication
Monotherapy	49 (20.2)	51 (18.3)	100 (19.2)	0.58
Combination therapy	193 (79.8)	227 (81.7)	420 (80.8)
ACE-inhibitors	100 (41.3)	127 (45.7)	227 (43.7)	0.32
ATR-blockers	107 (44.2)	121 (43.5)	228 (43.8)	0.87
ACE/ATR	203 (83.9)	247 (88.8)	450 (86.5)	0.10
Diuretics	152 (62.8)	145 (52.2)	297 (57.1)	0.01
Beta-blockers	148 (61.2)	165 (59.4)	313 (60.2)	0.67
Calcium channel blockers	79 (32.6)	128 (46.0)	207 (39.8)	0.002

^a Finnish 2009 Guideline.

^b EHS 2013 criteria for patients with diabetes.

^c EHS 2013 criteria for patients with hypertension.

^d N = 277.

^e t-test for independent samples was used for continuous variables and Chi-squared test for categorical variables.

Table 3. The achievement of blood pressure target <130/80 mmHg in association with gender, diabetic nephropathy, HbAC1 (%), eGFR and albuminuria.

	Systolic blood pressure (mmHg)	Diastolic blood pressure (mmHg)	Achievement of <130/80 mmHg^a
	Mean (SD; range)	Mean (SD; range)	n (%)
Gender
Women (n = 291)	142 (18; 104–220)	80 (11; 53–112)	51 (17.5)
Men (n = 334)	142 (17; 100–194)	81 (10; 55–113)	51 (15.3)
	p = 0.73	p = 0.31	p = 0.46
History of nephropathy diabetic
No (n = 473)	141 (17; 100–220)	81 (10; 53–113)	77 (16.3)
Yes (n = 152)	146 (19; 110–200)	79 (11; 56–112)	25 (16.6)
	p = 0.002	p = 0.02	p = 0.94
HbA1C (%)
<7.0 (n = 337)	141 (17; 104–194)	81 (10; 53–112)	48 (14.2)
7.0–8.5 (n = 189)	143 (19; 100–220)	80 (11; 56–113)	34 (18.0)
>8.5 (n = 99)	142 (18; 112–200)	80 (11; 56–112)	20 (20.4)
	p = 0.61	p = 0.41	p = 0.27
eGFR-EPI
≥90 ml/min/1.73m^2 (n = 249)	141 (16; 108–194)	83 (10; 56–113)	37 (14.9)
<90 ml/min/1.73m^2 (n = 376)	143 (18; 100–220)	78 (11; 53–112)	65 (17.3)
	p = 0.15	p < 0.001	p = 0.43
Albuminuria
Normal (n = 473)	140 (17; 100–194)	80 (11; 53–113)	88 (18.6)
Microalbuminuria (n = 107)	147 (20; 110–220)	80 (11; 55–105)	9 (8.5)
Macroalbuminuria (n = 45)	145 (16; 113–180)	81 (10; 63–112)	5 (11.1)
	p < 0.001	p = 0.88	p = 0.02

ANOVA was used for continuous variables and Chi-squared test for categorical variables.

^a Finnish 2009 Guideline.

Figure 1. Mean systolic and diastolic blood pressure (mmHg) and the achievement of <130/80 mmHg target (%) in relation to observed albuminuria (normal = green, micro = red or macro = blue) among 625 Finnish patients with diabetes. *p = 0.02, **p < 0.001.

Table 4. Urinary albumin–creatinine ratio (U-alb/crea), urine albumin secretion (cU–Alb–mi) and albuminuria in patients who were treated with antihypertensive medication. Results are compared between categories of achievement of the ESH 2013 blood pressure targets.

		Blood pressure target was achieved
		Yes		No
Variable	Blood pressure target	N	Median (IQR)	N	Median (IQR)	p^d
U-alb/crea (mg/mmol)	<140/90 mmHg^a	111	0.7 (0.4–1.8)	141	1.3 (0.6–3.3)	<0.001
	<140/85 mmHg[2]	97	0.8 (0.4–1.6)	155	1.3 (0.5–3.2)	0.004
cU–Alb–mi (mg/min)	<140/90 mmHg	105	4.0 (2.0–15.0)	136	8.0 (3.0–26.0)	0.02
	<140/85 mmHg	92	4.0 (2.0–14.0)	149	8.0 (3.0–30.0)	0.01
		N	%	N	%	p^e
Albuminuria^c	<140/90 mmHg
Normal		177	79.0	207	70.2	0.05
Microalbuminuria		30	13.4	63	21.4
Macroalbuminuria		17	7.6	25	8.5
Albuminuria	<140/85 mmHg
Normal		159	80.7	225	69.9	0.02
Microalbuminuria		26	13.2	67	20.8
Macroalbuminuria		12	6.1	30	9.3

^a ESH 2013 guideline for all patients with hypertension.

^b ESH 2013 guideline for patients with diabetes.

^c Normal if U-alb/crea is <2.5 mg/mmol in men and <3.5 mg/mmol in women and cU–Alb–mi <20 mg/min; microalbuminuria if U-alb/crea is 2.5–25 mg/mmol in men and 3.5–35 mg/mmol in women or cU–Alb–mi 20–200 mg/min; macroalbuminuria if U-alb/crea >25 mg/mmol in men and >35 mg/mmol in women or cU–Alb–mi >200 mg/min or U-Prot >0.

^d Mann–Whitney U–test.

^e Chi-squared test.

Finnish Statistics on Medicines. Finnish medicines agency FIMEA and social insurance innstitution. Helsinki: Edita Prima Oy; 2013. p. 126.

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