Routine eye examinations could serve as an important opportunity to identify undiagnosed or poorly controlled hypertension in people with diabetes, according to a new study published in JAMA Ophthalmology.
Researchers from the University of Virginia School of Medicine found that elevated blood pressure was extremely common among patients attending a diabetic retina clinic. Of the 172 adults with type 1 or type 2 diabetes included in the study, only 8.1% had normal blood pressure, while approximately half met the criteria for stage 2 hypertension. In addition, 10.5% had blood pressure readings consistent with a hypertensive crisis, a medical emergency that can lead to heart attack or stroke if left untreated.
Diabetes is closely linked to cardiovascular disease and diabetic retinopathy, with high blood pressure being one of the major factors contributing to retinal damage and vision-threatening complications such as macular edema. Despite this well-established connection, blood pressure screening is not routinely performed in many ophthalmology clinics.
During routine eye appointments, participants had their blood pressure measured before receiving pupil-dilating eye drops and completed a questionnaire about their history of hypertension, medication use, home blood pressure monitoring, and awareness of the relationship between blood pressure and eye health.
The findings revealed a significant gap between patients' perceptions and their actual cardiovascular health. Among participants who had never been diagnosed with hypertension, 85.7% had elevated blood pressure, and more than one-third already had stage 2 hypertension. Even among those who believed their blood pressure was well controlled, 52% still had stage 2 hypertension, while 8% were experiencing a hypertensive crisis.
The screening also prompted immediate medical intervention. Nearly 60% of participants were advised to contact their primary care physician, 11.6% required urgent follow-up within one to two days, and one patient was referred directly to the emergency department.
Patient acceptance of the screening was high, with 93% considering blood pressure measurement during eye examinations appropriate. Approximately 74% were already aware that uncontrolled hypertension could threaten their vision.
The researchers conclude that routine blood pressure assessment during ophthalmology visits could help identify previously unrecognized or inadequately controlled hypertension, enabling earlier treatment and potentially reducing the risk of cardiovascular complications as well as diabetes-related vision loss.
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