Sir,

We read with interest Sivaprasad and Jackson's1 finding that 65% of diabetic macular laser was performed on patients whose blood pressure (BP) was not adequately controlled as measured in the clinic. The Scottish Care Information-Diabetes Collaboration (SCI-DC) database provides an electronic patient record on all patients with diabetes in Scotland. Data are recorded from any clinic visit whether it is to the general practitioner , practice nurse, or hospital. We used these data to determine whether the BP measurement on a stressed patient, at the eye clinic preparing to receive bad news about their sight, is accurate.

Of the 86 new patients with diabetic retinopathy attending our Diabetic Eye Clinic over a 5-month period, 97% had a BP measurement found on the SCI-DC database.

We found that clinic BPs were significantly higher than those on the SCI-DC database. The systolic BP was 18.0±18.8 mmHg (mean±SD) higher in the eye clinic (P<0.01) and the diastolic was 10.1±12.5 mmHg (mean±SD) higher (P<0.01).

Only 20% had a systolic BP⩽140 and 22.2% had a diastolic BP⩽80 when BP was measured at the eye clinic. However, the SCI-DC measurements showed that 67 and 70% were reaching these targets respectively.

We feel that the BP measurements taken at the diabetic eye clinic may not be accurate. However, only 65% of patients had a BP recorded on SCI-DC within the last 6 months. Although NHS Quality Improvement Scotland standard 42 suggests that the BP review is only carried out ‘on an annual basis’, we know that our patients are at high-risk of worsening retinopathy if BP is not controlled.3 We, therefore, now only check the BP if there is no measurement available on SCI-DC during the last 6 months, especially if there is significant retinopathy. The information from this database helps us to target patients more effectively and use our resources more efficiently.