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(Circulation. 2008;117:1355-1357.)
© 2008 American Heart Association, Inc.

Editorial

Actively Engaging Patients in Treatment Decision Making and Monitoring as a Strategy to Improve Hypertension Outcomes in Diabetes Mellitus

Michele Heisler, MD, MPA

From the VA Center for Clinical Practice Management Research, Department of Internal Medicine, University of Michigan, Ann Arbor.

Correspondence to Michele Heisler, MD, MPA, VA Center for Clinical Practice Management Research, Department of Internal Medicine, University of Michigan, 2215 Fuller St, 11H, Ann Arbor, MI 48109. E-mail mheisler@umich.edu

Key Words: Editorials • communication • hypertension • patients

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Good blood pressure (BP) control is a central outcome of high-quality diabetes care.¹ In the landmark UK Prospective Diabetes Study (UKPDS), intensive BP control led to an absolute risk reduction of 11.2% in diabetes end points over 10 years, an effect 3.5 times greater than intensive blood glucose control.² Moreover, although intensive glycemic or cholesterol control has an incremental cost-effectiveness of $40 000 to $50 000 per quality-adjusted life-year, intensive BP control actually saves almost $2000 per quality-adjusted life-year.³ For these reasons, the American Diabetes Association and the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High BP (JNC 7) recommend a BP goal of <130/80 mm Hg in persons with diabetes mellitus.⁴ Yet, from 47% to 70% of patients with diabetes do not achieve that goal.^5,6

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Physicians face a significant challenge in helping patients take the necessary steps to improve BP control. Physicians are responsible for prescribing the best medications, completing necessary tests and procedures, and providing guidance in relevant treatment areas. But patients are responsible for implementing the often complicated treatment recommendations over a sustained period of time ("self-management"). In the words of Glasgow and Anderson,⁷ 2 leading chronic disease experts, "Patients are in control. No matter what we as health professionals do or say, patients are in control of these important self-management decisions. When patients leave the clinic or office, they can and do veto recommendations their doctor makes." Patients frequently disagree with physicians’ diagnoses and treatment plans, leading to unfilled prescriptions, . . . [Full Text of this Article]