People with diabetes and hypertension are less likely to comply with
nutritional recommendations for lowering blood pressure than people
with hypertension alone, Sundar Natarajan, MD, MS, reported here at
the American Public Health Association 136th Annual Meeting.

The findings suggest that these patients may require more intensive
intervention to ensure they achieve nutritional goals, Dr.
Natarajan, an assistant professor of medicine at New York University
School of Medicine, said during his oral presentation.

He and his colleagues analyzed data from 177 hypertensive patients
enrolled in a trial to improve antihypertensive treatment. Patients
were eligible for inclusion in the study if they had uncontrolled
hypertension and had been taking antihypertensive medication for at
least 6 months. Of the 177 patients, 89 had diabetes as well as
hypertension. The study was conducted at a Veterans Affairs
hospital, so 86 of those in the diabetes group and all of those in
the hypertension-only group were male. The mean age for all subjects
was 65 years, and their mean body mass index was 31 kg/m2.

The investigators assessed diet in 2 ways. To get an idea of overall
nutrient intake, they had patients fill out the 61-item self-
administered Willett Food Frequency Questionnaire. The subjects also
completed the Healthy Eating Index (HEI), an instrument created in
1995, by the Center for Nutrition Policy and Promotion at the United
States Department of Agriculture, to evaluate the overall quality of
a person's diet. It was revised in 2006 to reflect the 2005 Dietary
Guideline for Americans. The HEI rates an individual's compliance
with the guidelines for 12 food groups or nutrients, such as fruits,
vegetables, whole grains, and sodium. The maximum score is 100;
scores over 80 are considered good, scores between 51 and 80 are
considered fair, and scores below 51 are considered poor.

People with diabetes and hypertension had a mean HEI score of 65.8,
compared with a mean of 69.1 for people with hypertension only (P
< .05). Their diets contained significantly less calcium, magnesium,
and potassium. On a more positive note, they consumed a mean of 1607
calories per day, compared with 1837 for people with hypertension
alone. The mean dietary glycemic load was 102 units and 120 units,
respectively (P < .01 for both groups).

These findings suggest that overall dietary quality is worse for
people with diabetes and hypertension than it is for people with
hypertension alone, Dr. Natarajan told Medscape Public Health &
Prevention. "I was surprised. I would have thought patients with
both diagnoses would get more education." However, he added,
nondietary factors could have come into play. "When people have
diabetes they often have other issues, such as depression. Also,
they were veterans, so they may have had other mental-health issues
that may have affected their eating behavior." It is also possible
that rather than too little education, they received too much. "They
may have been overwhelmed with information," he explained. "As
clinicians, sometimes we assume people remember everything we tell
them, but that isn't always the case."

At least 1 independent observer also expressed surprise at these
findings. "It seems we have to make different recommendations to
these patients," said Adelia Bothell-Benjamin, PhD, research
associate professor of food and nutritional sciences at Tuskegee
University in Alabama. "If this is not just a 1-time finding, it
suggests we have to do more for patients when the 2 conditions
coexist."

American Public Health Association (APHA) 136th Annual Meeting:
Abstract 183326. Presented October 29, 2008.