By Brenda L. Mooney

ANN ARBOR, MI — VA clinicians may be doing too good of a job of controlling blood pressure in patients with diabetes, according to research suggesting that as many as 8% of those veterans may have been overtreated.

Eve Kerr, MD, director of the Center for Clinical Management Research at the VA Ann Arbor, MI, Healthcare System and professor of internal medicine at the University of Michigan Medical School.

In the study, “Monitoring Performance for Blood Pressure Management Among Patients With Diabetes Mellitus: Too Much of a Good Thing?Monitoring Performance for BP Management in Diabetes,” researchers note VA’s “impressive progress” in increasing blood pressure (BP) management in patients with diabetes. They also caution, however, that, because of broad performance measures, it “appears that in the VA, rates of potential overtreatment are currently approaching, and perhaps even exceeding, the rate of undertreatment and that high rates of achieving current performance measurement targets are directly associated with medication escalation that may increase risk for patients.” ¹

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For the research, published recently in the Archives of Internal Medicine, investigators conducted a retrospective cohort study in 879 VA medical centers and smaller community-based outpatient clinics. They looked at how clinicians met the clinical action measure for hypertension in 2009-2010, defined as the patient having a passing index BP at the visit or receiving an appropriate intervention.

“Appropriately treating blood pressure in people with diabetes is extremely important, and good blood pressure control should still be the goal to reduce risk of heart attack, stroke and other conditions,” said lead author Eve Kerr, MD, director of the Center for Clinical Management Research at the VA Ann Arbor, MI, Healthcare System and professor of internal medicine at the University of Michigan Medical School.

“But just treating to a BP target in all patients may result in overtreating and harming some patients because their blood pressures actually fall too low,” Kerr noted in a statement. “We need to find better ways to measure and incentivize appropriate BP management to make sure that patients who need aggressive treatment are getting it and to decrease the rate of inappropriate overtreatment."

Of 977,282 established VA patients with diabetes mellitus (DM), 713,790 patients were eligible for the action measure; and 94% passed the measure. Of those, 82% had a BP <140/90 mm Hg at the visit. An additional 12% had high BP, ≥140/90 mm Hg, but appropriate clinical action was taken.