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Quality of Hypertension Management in Type 2 Diabetes in India: A Multisite Prescription Audit.

Background and Objective
Renin-angiotensin system (RAS) blockers (angiotensin converting enzyme inhibitors ACEI, angiotensin receptor blockers, ARB) are preferred drugs to control hypertension among diabetic patients. To determine frequency of RAS blocker use in hypertensive patients with type 2 diabetes, we performed a multisite study in India.


Methods
We evaluated physician prescriptions in consecutive patients with type 2 diabetes at 9 sites in India. Details of socio-demographic characteristics, clinical findings and prescription medicines were obtained. Descriptive statistics are reported.


Results
Hypertension treatment details were available in 8056 of 8699 diabetic patients (4829 men, 3227 women). No hypertension was in 3300 (40.9%), hypertension in 3625 (45.0%), and hypertension with vascular disease in 1131 (14.0%). In diabetics with no hypertension, hypertension, and hypertension with vascular disease, respectively, prescriptions of antihypertensive drugs was: RAS blockers in 19.4, 48.2 and 58.1%, beta-blockers in 4.8, 31.6 and 38.8%, calcium channel blockers in 0.4, 27.4 and 14.3% and diuretics in 0.6, 36.4 and 17.1%. ACEIs were prescribed more frequently than ARB's in hypertensive diabetics (60.7 vs 39.2%) as well as in diabetics with vascular disease (58.6 vs 41.4%). In diabetics with hypertension (n=3625) prescription of one, two or three antihypertensive drugs was 49.8%, 33.7% and 3.5% while statins were prescribed in 54.1%.


Conclusion
Use of RAS blockers (ACEI or ARB) in uncomplicated as well as complicated hypertensive patients with type 2 diabetes is sub-optimal. Most of the patients are on one drug and prescription of ≥3 drugs are rare. Statins are prescribed in only a half.