Hypertension Treatment and Control in Canadians With Diabetes
Bibliographic record
Abstract
OBJECTIVES: In this study, we investigated hypertension control (<130/80 mmHg) among individuals with diabetes, use of first-line antihypertensive medications, and physician responses to uncontrolled blood pressure (BP) measurements (i.e. repeat measurements and medication intensification). METHODS: We performed a descriptive retrospective cohort study of adults with prevalent diabetes and hypertension followed at Ontario primary care practices, from their first BP measurement from 2013 to 2017, using the IQVIA (IQVIA Solutions Canada, Kirkland, Québec, Canada) data set. We characterized baseline BP control and antihypertensive therapy and followed these individuals over 24 months. We followed a nested cohort of individuals with uncontrolled BP readings (≥130/80 mmHg) to ascertain the frequency of guideline-concordant care, consisting of repeat BP assessment and drug intensification (dose increase, additional drug class prescription) within 6 weeks. RESULTS: Of the 10,814 adults included in the study, 7,437 (69%) had a BP≥130/80 mmHg (46% with BP≥140/90 mmHg). Baseline mean BP was 139.4/84.4 mmHg and appeared similar at 24 months. At baseline, most individuals were receiving monotherapy (60%), with 90% prescribed renin-angiotensin-aldosterone system inhibitors. Only 34% of individuals were prescribed dihydropyridine calcium channel blockers and 24% were prescribed thiazide/thiazide-like diuretics. Physicians infrequently arranged timely (within 6 weeks) repeat BP checks (50%), dose increases (18%), and medication additions (33%) after uncontrolled BP readings. CONCLUSIONS: The large majority of people with diabetes and hypertension had uncontrolled BP that persisted over 2 years. Therapeutic inertia, lack of follow-up, and underprescribing of dual and triple combination therapy contributed to persistently high BP measurements, demonstrating the need for improvements.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.003 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".