Historical Gaps in Kidney and Cardiovascular Risk Assessment Among Patients with Diabetes and Hypertension: A Real-World Primary Care Study.

INTRODUCTION Individuals with both diabetes and hypertension are at high risk for micro- and macrovascular complications, underscoring the importance of regular monitoring of HbA1C, cholesterol, urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR).

Methods

We analyzed laboratory tests from 4,456 adults from primary care practices with diabetes and hypertension, each with at least two blood pressure measurements between January 1, 2013, and December 31, 2017, and at least one test (HbA1C, UACR, eGFR, and LDL-C) within two years. Test completion rates and results were reported across three blood pressure categories: controlled (<130mmHg/<80mmHg), stage 1 hypertension (130-139mmHg/80-89mmHg), and stage 2 hypertension (≥140mmHg/≥90mmHg).

Results

Of the 4,456 individuals, 86% had HbA1C tested, 32% had UACR, 76% had eGFR, and 83% had LDL-C. Among those tested, 43% had HbA1c >7.0%, 11% had macroalbuminuria (UACR >20mg/mmol), 20% had chronic kidney disease (CKD) (eGFR <60mL/min/1.73m2), and 54% had dyslipidemia (LDL-C ≥2.0mmol/L). Those with stage 2 hypertension had higher rates of albuminuria, CKD, and dyslipidemia compared to those with controlled or stage 1 hypertension.

Conclusions

Our study has three key findings. UACR testing was underutilized among patients with diabetes and hypertension. Consistent screening could have identified individuals who would benefit from guideline directed antiproteinuric therapies. Uncontrolled blood pressure was associated with higher rates of albuminuria and dyslipidemia. Achievement of LDL-C < 2.0 mmol/L was suboptimal, in over 50% of patients, necessitating improved cardiovascular risk management in this high-risk group.