Physicians know how to manage complicated hypertension – but treating hypertension in patients with diabetes is challenging in practice

Background Antihypertensive medication of patients with coronary artery disease follows national guidelines, but antihypertensive medication of patients with diabetes is not optimal.

Methods We collected and analysed data from the patient administration system of Turku city health centre. Hypertensive patients who had been diagnosed with diabetes, coronary artery disease or atrial fibrillation, and who had renewed at least one prescription in 2017, were included in the study. In addition, we used a questionnaire to collect data from physicians on prescribing practices with regard to antihypertensive drugs.

Results In our study, one fifth of patients who had both hypertension and diabetes were taking beta-blockers as the only antihypertensive medication. Beta-blocker+ACE (angiotensin converting enzyme) inhibitor / ARB (angiotensin receptor blocker) was the most common combination in hypertensive patients who had coronary artery disease or atrial fibrillation. Diuretic+ACE inhibitor / ARB was the most common combination in hypertensive patients who had diabetes.

The questionnaire data showed that ACE inhibitor / ARB was the first-line antihypertensive drug in the treatment of hypertension. Beta-blockers were often prescribed for patients with coronary artery disease.

Conclusions Physicians are familiar with the Finnish evidence-based medicine guidelines for managing hypertension. In patients with diabetes, beta-blockers were often used as the only antihypertensive medication and also in combination with diuretics, which is not in accordance with the guidelines. Therefore, physicians should pay attention to the indications for beta-blockers.