Routine eye exams reveal stage 2 hypertension in half of patients with diabetes

Diabetes opens people to other noncommunicable diseases like obesity, retinopathy and cardiovascular diseases like heart attacks and hypertension. A recent study by researchers at the University of Virginia School of Medicine sought to understand how common high blood pressure (BP) was among people with diabetes. They measured the BP of 172 adults with type 1 or type 2 diabetes and asked for their opinions on being screened during their eye exams.

Uncontrolled blood pressure was a common finding among the patients. Of the entire cohort, only about one in 12 had a normal blood pressure reading. Roughly half of the patients had stage 2 hypertension. They also found that about 10.5% had BP levels in the hypertensive crisis range—a level at which BP becomes a medical emergency because, if left untreated, it can lead to serious events such as a heart attack or stroke.

Having their blood pressure checked at the eye doctor was considered reasonable and acceptable by 93% of patients, as many were unaware they had a medical condition that needed attention, and some were under the impression that their BP was under control.

The findings are published in JAMA Ophthalmology.

Diabetes and its accomplice

In people with diabetes, diabetic retinopathy is a common complication of systemic vascular disease. It is largely driven by high blood pressure, and it leads to complications such as retinal damage and macular edema—swelling in the central retina due to fluid buildup.

Despite decades of evidence linking hypertension and diabetes to retinal outcomes, ophthalmology clinics have typically remained focused on managing eye disease once it presents.

Eye clinics are a good place to catch high blood pressure, as many patients who visit the clinics already have diabetes and the vascular risks that come with it. Earlier studies in diabetic eye clinics support this pattern, reporting high rates of high blood pressure and identifying new cases of hypertension during routine eye visits.

In the LIPSIA study, which examined patients with diabetic macular edema, most were already receiving antihypertensive treatment, yet a substantial proportion still had blood pressure readings above target.

At-clinic monitoring

In this study, the researchers used a prospective case series design, following a specific group of people to track how a particular health issue unfolded over time. They selected people with diabetes who were already visiting the University of Virginia Eye Clinics for medical care.

During a regular eye appointment, clinic staff checked each patient's blood pressure before giving them any eye-dilating drops to ensure accurate readings. The participants were also asked to fill out a questionnaire with simple questions about their blood pressure: whether they had a history of hypertension, if they were taking medication, how often they checked it at home, whether they knew it could affect their eyesight, and what they thought about having it measured as part of an eye appointment.

The researchers compared the measured BP with the official 2017 medical guidelines used by heart specialists and found that only 8.1% had normal BP levels. It also revealed both undiagnosed and poorly controlled hypertension.

Among patients with no prior diagnosis, 85.7% had above-normal BP, and 35.7% were already in stage 2 hypertension territory—when systolic pressure is 140 mm Hg or higher or diastolic pressure is 90 mm Hg or higher.

Among those who believed their hypertension was well controlled, 52% still had stage 2 hypertension, and 8% were in hypertensive crisis. The findings also led to immediate action, as 59.9% were advised to contact their primary care provider, 11.6% required follow-up within one to two days, and one patient was referred to the emergency department.

Most patients were on board with the idea of getting eye clinic BP measurements, and about 74% already understood that high blood pressure can damage their vision, so the system made sense to them.

The researchers highlight that the numbers exposed a real gap between perception and reality. What patients believed about their blood pressure control often didn't match what the numbers actually showed. They argue this disconnect makes a strong case for making blood pressure checks a standard part of every ophthalmology visit.

This article was originally published on MedicalXpress Breaking News-and-Events.