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.
References
Sivaprasad S, Jackson H . Blood pressure control in type II diabetics with diabetic retinopathy. Eye 2007; 21: 708–711.
Clinical Standards Board for Scotland. Clinical Standards Diabetes; October 2002.
Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. UKPDS 38. UK Prospective Diabetes Study Group. BMJ 1998; 317 (7160): 703–713.
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Styles, C., Timlin, H. The relevance of blood pressure measurements in patients attending a diabetic eye clinic: the use of an electronic patient record. Eye 21, 1450 (2007). https://doi.org/10.1038/sj.eye.6702968
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DOI: https://doi.org/10.1038/sj.eye.6702968