Management of Hypertension and Diabetes Mellitus in Patients with Target Organ Damages and/or Previous Cardiovascular Diseases in Lebanon. Where do We Stand with Respect to International Guidelines?

Background: Hypertension and diabetes are major health problems worldwide. They can coexist together increasing the complication rates. The increased incidence of these complications in the Lebanese population reflects a poor disease control, consequently increased risk of death. Objective: The aim of this study was to assess Lebanese physicians’ compliance to international guidelines and their control on diabetes and hypertension. Methods: Retrospective cross-sectional study was conducted on 750 Lebanese patients randomly selected from 6 university hospitals from January 2014 to August 2015. Patients were divided according to their medical history: 252 hypertensive, 249 diabetic, 249 both hypertensive and diabetic. All patients had target organ damages and were admitted to the hospitals. Cardiol Cardiovasc Med 2020; 4 (6): 679-696 DOI: 10.26502/fccm.92920162 Cardiology and Cardiovascular Medicine Vol. 4 No. 6 December 2020. [ISSN 2572-9292] 680 Results: Our study showed the overuse of beta blockers in hypertensive and diabetic patients, while neglecting lifestyle modifications and the drug of choice for special populations. A proportion of 7% of hypertensive patients in the Lebanese population were untreated for their hypertension. The first line treatment for diabetic patients was respected in most of the patients. However, results showed those with diabetes were not properly controlled. Aspirin was only used in half of the patients, though all of them were high-risk with target organ damages. Discussion: Results from this study in Lebanon indicate the absence of adherence to guidelines by the Lebanese physicians, especially in the management of hypertension where beta blockers were overused, in addition to the absence of control of diabetes and hypertension, which may be due to physicians’ non adherence to guidelines or patients’ noncompliance to medications.

[1]  C. Patrono,et al.  Aspirin in the primary prevention of cardiovascular disease in diabetes mellitus: A new perspective. , 2020, Diabetes research and clinical practice.

[2]  J. Redón,et al.  Blood Pressure Targets Achievement According to 2018 ESC/ESH Guidelines in Three European Excellence Centers for Hypertension , 2020, High Blood Pressure & Cardiovascular Prevention.

[3]  N. Poulter,et al.  Rates of untreated, treated, and controlled hypertension and relationships between blood pressure with other cardiovascular risk factors in Brazzaville (Republic of the Congo): May Measurement Month 2017—Sub-Saharan Africa , 2019, European heart journal supplements : journal of the European Society of Cardiology.

[4]  S. Hadjadj,et al.  Lower limb events in individuals with type 2 diabetes: evidence for an increased risk associated with diuretic use , 2019, Diabetologia.

[5]  Thomas Kahan,et al.  [2018 ESC/ESH Guidelines for the management of arterial hypertension]. , 2019, Kardiologia polska.

[6]  M. Rocco,et al.  Use of Renin-Angiotensin System Blockade in Advanced CKD: An NKF-KDOQI Controversies Report. , 2018, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[7]  Diane M. Miller,et al.  Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial. , 2018, Lancet.

[8]  Joaquín T. Limonero,et al.  Effectiveness of primary healthcare educational interventions undertaken by nurses to improve chronic disease management in patients with diabetes mellitus, hypertension and hypercholesterolemia: A systematic review. , 2018, International journal of nursing studies.

[9]  P. Rothwell,et al.  Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial , 2018, The Lancet.

[10]  Zengwu Wang,et al.  Effect of long-term lifestyle intervention on mild cognitive impairment in hypertensive occupational population in China , 2018, Medicine.

[11]  J. Lewis,et al.  Update on Diabetic Nephropathy: Core Curriculum 2018. , 2018, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[12]  Jingzhou Jiang,et al.  Real role of β-blockers in regression of left ventricular mass in hypertension patients: Bayesian network meta-analysis: Erratum , 2018, Medicine.

[13]  F. Greenway,et al.  Long-Term Effects of an Intensive Lifestyle Intervention on Electrocardiographic Criteria for Left Ventricular Hypertrophy: The Look AHEAD Trial , 2018, American journal of hypertension.

[14]  A. Scheen.  Type 2 Diabetes and Thiazide Diuretics , 2018, Current Diabetes Reports.

[15]  A. Hall,et al.  The Divergent Cardiovascular Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Type 1 Receptor Blockers in Adult Patients With Type 2 Diabetes Mellitus. , 2017, Canadian journal of diabetes.

[16]  K. Kalantar-Zadeh,et al.  Changes in Albuminuria and Subsequent Risk of Incident Kidney Disease. , 2017, Clinical journal of the American Society of Nephrology : CJASN.

[17]  Fan Zhang,et al.  Effects of RAAS Inhibitors in Patients with Kidney Disease , 2017, Current Hypertension Reports.

[18]  M. Lazo,et al.  Association between family history of diabetes and cardiovascular disease and lifestyle risk factors in the United States population: The 2009-2012 National Health and Nutrition Examination Survey. , 2017, Preventive medicine.

[19]  D. Mengistu,et al.  Adherence to recommended lifestyle modifications and factors associated for hypertensive patients attending chronic follow-up units of selected public hospitals in Addis Ababa, Ethiopia , 2017, Patient preference and adherence.

[20]  S. Daskalopoulou,et al.  Physician step prescription and monitoring to improve ARTERial health (SMARTER): A randomized controlled trial in patients with type 2 diabetes and hypertension , 2017, Diabetes, obesity & metabolism.

[21]  K. Khunti,et al.  Clinical inertia to insulin initiation and intensification in the UK: A focused literature review. , 2017, Primary care diabetes.

[22]  F. Locatelli,et al.  Use of ACE inhibition and blood pressure management in deferring dialysis initiation. , 2017, Panminerva medica.

[23]  H. Neuhauser,et al.  Untreated, Uncontrolled, and Apparent Resistant Hypertension: Results of the German Health Examination Survey 2008–2011 , 2016, Journal of clinical hypertension.

[24]  K. Bailey,et al.  Comparison of Blood Pressure Control Rates Among Recommended Drug Selection Strategies for Initial Therapy of Hypertension. , 2016, American journal of hypertension.

[25]  A. Ades,et al.  Classes of antihypertensive agents and mortality in hypertensive patients with type 2 diabetes-Network meta-analysis of randomized trials. , 2016, Journal of diabetes and its complications.

[26]  P. Pai,et al.  Angiotensin receptor blockers (ARB) outperform angiotensin-converting enzyme (ACE) inhibitors on ischemic stroke prevention in patients with hypertension and diabetes - A real-world population study in Taiwan. , 2016, International journal of cardiology.

[27]  H. Parving,et al.  Prevention of microalbuminuria using early intervention with renin-angiotensin system inhibitors in patients with type 2 diabetes: A systematic review , 2016, Journal of the renin-angiotensin-aldosterone system : JRAAS.

[28]  Basavanagowdappa Hathur,et al.  Factors Contributing to Development and Reversal of LVH: A Pilot Study. , 2016, Journal of clinical and diagnostic research : JCDR.

[29]  S. Peixoto,et al.  Diabetes, hypertension and mobility among Brazilian older adults: findings from the Brazilian National Household Sample Survey (1998, 2003 and 2008) , 2015, BMC Public Health.

[30]  I. Narita,et al.  Benefits of a 12-week lifestyle modification program including diet and combined aerobic and resistance exercise on albuminuria in diabetic and non-diabetic Japanese populations , 2015, Clinical and Experimental Nephrology.

[31]  S. Mallat,et al.  Identifying predictors of blood pressure control in the Lebanese population - a national, multicentric survey – I-PREDICT , 2014, BMC Public Health.

[32]  K. Bennett,et al.  Prevalence, correlates and management of type 2 diabetes mellitus in Lebanon: findings from a national population-based study. , 2014, Diabetes research and clinical practice.

[33]  D. Platt,et al.  Multivariate epidemiologic analysis of type 2 diabetes mellitus risks in the Lebanese population , 2014, Diabetology & Metabolic Syndrome.

[34]  A. Sibai,et al.  Trends in nutritional intakes and nutrition-related cardiovascular disease risk factors in Lebanon: the need for immediate action. , 2014, Le Journal medical libanais. The Lebanese medical journal.

[35]  N. Hwalla,et al.  Factors associated with consulting a dietitian for diabetes management: a cross-sectional study , 2013, BMC Health Services Research.

[36]  V. Mohan,et al.  The Rising Burden of Diabetes and Hypertension in Southeast Asian and African Regions: Need for Effective Strategies for Prevention and Control in Primary Health Care Settings , 2013, International journal of hypertension.

[37]  J. Chudek,et al.  Do primary care physicians follow the current recommendations for hypertensive pharmacotherapy? , 2013, Polskie Archiwum Medycyny Wewnetrznej.

[38]  S. Azar,et al.  Management and control of patients with type 2 diabetes mellitus in Lebanon: results from the International Diabetes Management Practices Study (IDMPS). , 2013, Le Journal medical libanais. The Lebanese medical journal.

[39]  W. Cushman,et al.  Diabetes and hypertension: the bad companions , 2012, The Lancet.

[40]  M. Castelo-Branco,et al.  Blood pressure control and antihypertensive pharmacotherapy patterns in a hypertensive population of Eastern Central Region of Portugal , 2010, BMC health services research.

[41]  M. Moser.  Physician or Clinical Inertia: What Is It? Is It Really a Problem? And What Can Be Done About It? , 2009, Journal of clinical hypertension.

[42]  B. Kestenbaum,et al.  Insulin therapy, hyperglycemia, and hypertension in type 1 diabetes mellitus. , 2008, Archives of internal medicine.

[43]  W. Elliott,et al.  Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis , 2007, The Lancet.

[44]  R. Schmieder,et al.  Guidelines for management of arterial hypertension , 2007 .

[45]  R. Sequeira,et al.  Pharmacotherapy and blood pressure control in elderly hypertensives in a primary care setting in Bahrain , 2004, Aging clinical and experimental research.

[46]  G. Lip,et al.  Platelet indexes in relation to target organ damage in high-risk hypertensive patients: a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT). , 2004, Journal of the American College of Cardiology.

[47]  Claude Lenfant,et al.  Definition of Metabolic Syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition , 2004, Arteriosclerosis, thrombosis, and vascular biology.

[48]  E. Battegay.  [Modern therapy of hypertension]. , 2003, Praxis.

[49]  Treatment of hypertension in adults with diabetes. , 2002, Diabetes care.

[50]  A. Siebenhofer,et al.  Betablocker treatment in diabetes mellitus , 2001, Journal of internal medicine.

[51]  C. Baird,et al.  The pilot study. , 2000, Orthopedic nursing.

[52]  M. Akel,et al.  Quality of diabetes care in a university health center in Lebanon. , 1999, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[53]  L. Ruilope,et al.  How to treat the diabetic hypertensive individual appropriately. , 1998, Journal of hypertension. Supplement : official journal of the International Society of Hypertension.

[54]  C. Jazra,et al.  [Profile of the care of arterial hypertension: questionnaire addressed to Lebanese physicians]. , 1997, Le Journal medical libanais. The Lebanese medical journal.

[55]  J. Bloodworth.  Diabetes mellitus and vascular disease. , 1973, Postgraduate medicine.