ORIGINAL ARTICLE Hypertension in diabetes: trends in clinical control in repeated large-scale national surveys from Sweden PM Nilsson 1 , S Gudbjo ¨ rnsdottir 2 , B Eliasson 2 and J Cederholm 3 for the Steering Committee of the National Diabetes Register, Sweden 1 Department of Medicine, University Hospital, Malmo ¨, Sweden; 2 Diabetes Centre, Sahlgrenska University Hospital, Go ¨teborg, Sweden; 3 Family Medicine Section, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden Hypertension in diabetes is an important and treatable cardiovascular risk factor. Treatment targets from guide- lines cannot always be achieved in everyday clinical practice. It is therefore of great importance to monitor trends in hypertension control in defined populations. Patients with type I diabetes (range 6685–10 100; treated hypertension 21–29%) or with type II diabetes (range 15 935–22 605; treated hypertension 47–56%) were in- cluded in four national samples between 1996 and 1999. This screening was part of the procedures for the National Diabetes Register in Sweden, which monitors trends in clinical practice and risk factors for patients with diabetes, recruited both in primary health care and at the hospital level. A favourable trend in mean and median blood pressure levels was noticed during the 4-year study period, based either on data from repeated surveys or on repeated measures in the same individual, both for type I diabetes (mean: 2/2 mmHg; Po0.01) and for type II diabetes (mean: 5/3 mmHg; Po0.001). Correspondingly, the proportion of hypertensive patients in acceptable control of blood pressure (p140/ 85 mmHg) increased (Po0.001) both in type I diabetes (52.0–57.9%) and in type II diabetes (22.4–33.3%). It was concluded that hypertension is a widespread cardiovas- cular risk factor in patients with diabetes, especially systolic hypertension. A trend for a better systolic blood pressure control during the late 1990s in hypertensive patients with type II diabetes in Sweden could translate into substantial (estimated) clinical benefits in cardiovas- cular and diabetes-related morbidity. The National Dia- betes Register makes a quality assessment of the hypertension treatment possible. Journal of Human Hypertension (2003) 17, 37–44. doi:10.1038/sj.jhh.1001503 Keywords: blood pressure; diabetes; hypertension; myocardial infarction; register; stroke Introduction Hypertension is a common and important cardio- vascular risk factor in diabetes mellitus, with major implications not only for increased morbidity and mortality 1 but also for health care costs. 2 Inter- national guidelines have repeatedly stressed the importance of hypertension control in all patients with diabetes. 3–6 These guidelines are based on published data from several randomised inter- vention studies performed in both type I diabetes 7 and type II diabetes, such as the United Kingdom Prospective Diabetes Study (UKPDS) 8 and Hyper- tension Optimal Treatment (HOT) study. 9 These large-scale studies have proven the clinical benefits of tight blood pressure control for renal protection and prevention of cardiovascular events in patients with diabetes. However, in the diabetic population at large, the level of blood pressure control is often far from optimal, as the standards of care delivered in clinical studies cannot always be achieved outside the study settings. It is therefore of interest to compare population-based data from repeated na- tional surveys, in order to investigate if clinical practice in hypertension management and care has changed during recent years as measured by changes in mean/median blood pressure levels as markers of hypertension control. A change for the better in blood pressure control could be anticipated because of the possible influence of new treatment guide- lines 3–6 and the important UKPDS findings. 8 This has so far not been proven in national studies. According to an observational analysis of changes in median blood pressure levels in the UKPDS, a decrease of 10 mmHg in mean in-study systolic blood pressure levels corresponds, for example, to a reduction of 12% for any complications related to Received 17 May 2002; revised and accepted 11 October 2002 Correspondence: Dr P Nilsson, Department of Medicine, University Hospital, S-205 02 Malmo ¨, Sweden. E-mail: Peter.Nilsson@medforsk.mas.lu.se Journal of Human Hypertension (2003) 17, 37–44 & 2003 Nature Publishing Group All rights reserved 0950-9240/03 $25.00 www.nature.com/jhh