Impact of delaying blood pressure control in patients with Type 2 diabetes: results of a decision analysis

Abstract

Background: In patients with diabetes, delays in controlling blood pressure are common, but the harms of delays have not been quantified.

Objective: To estimate the harms of delays in controlling systolic blood pressure in middle-aged adults with newly diagnosed Type 2 diabetes.

Design: Decision analysis using diabetes complication equations from the United Kingdom Prospective Diabetes Study (UKPDS).

Participants: Hypothetical population of adults aged 50 to 59 years old with newly diagnosed Type 2 diabetes based on characteristics from the National Health and Nutrition Examination Surveys.

Intervention: Delays in lowering systolic blood pressure from 150 (uncontrolled) to 130 mmHg (controlled).

Main measures: Lifetime complication rates (amputation, congestive heart failure, end-stage renal disease, ischemic heart disease, myocardial infarction, and stroke), average life expectancy and quality-adjusted life expectancy (QALE).

Key results: Compared to a lifetime of controlled blood pressure, a lifetime of uncontrolled blood pressure increased complications by 1855 events per 10,000 patients and decreased QALE by 332 days. A 1-year delay increased complications by 14 events per 10,000 patients and decreased QALE by 2 days. A 10-year delay increased complications by 428 events per 10,000 patients and decreased QALE by 145 days. Among complications, rates of stroke and myocardial infarction increased to the greatest extent due to delays. With a 20-year delay in achieving controlled blood pressure, a baseline blood pressure of 160 mmHg decreased QALE by 477 days, whereas a baseline of 140 mmHg decreased QALE by 142 days.

Conclusions: Among middle-aged adults with diabetes, the harms of a 1-year delay in controlling blood pressure may be small; however, delays of ten years or more are expected to lower QALE to the same extent as smoking in patients with cardiovascular disease.

Figure 1.

Model framework. Abbreviations: CHF, congestive heart failure; ESRD, end-stage renal disease; IHD, ischemic heart disease; MI, myocardial infarction.

Figure 2.

Harm of delays in controlling systolic blood pressure on individual diabetes complication rates.

Figure 3.

Harm of delays in controlling systolic blood pressure on life expectancy and quality-adjusted life expectancy.

Figure 4.

Harm of delays in controlling systolic blood pressure on quality-adjusted life expectancy with different starting systolic blood pressure levels.