Association between Systolic Blood Pressure and Diabetic Retinopathy in Both Hypertensive and Normotensive Patients with Type 2 Diabetes: Risk Factors and Healthcare Implications

Abstract

A common diabetes-related microvascular complication is diabetic retinopathy (DR), yet associations between blood pressure (BP) and risks for DR in diabetic patients with normal BP received inadequate attention. This may lead to ‘clinical inertia’ in early DR prevention. We aimed to assess whether the extent to which systolic BP levels were associated with DR in patients with type 2 diabetes (T2DM) and normal BP were similar to that in those with concurrent hypertension. Data were collected from patients with T2DM attending ophthalmic check-up with primary care referral (n = 2510). BP measurements, clinical laboratory tests, and dilated fundus examination were conducted according to gold standard of diagnosis and routine clinical procedure. Of all subjects, over 40% were normotensive and one fifth were clinically diagnosed with DR. Systolic BP levels increased across DR categories of escalated severity irrespective of the coexistence of hypertension. Ordinal logistic regression analysis showed that an increased systolic BP was independently and significantly associated with DR (adjusted odds ratio [aOR] = 1.020, p < 0.001 for hypertensives; aOR = 1.019, p = 0.018 for normotensives), after adjusting for diabetes duration, sex, lifestyles, and haemoglobin A1c levels. Regular monitoring of systolic BP should not be neglected in routine diabetes management even when BP falls within the normal range. (200 words)

An analysis of DPV and DIVE registry patients with chronic kidney disease according to the finerenone phase III clinical trial selection criteria

“…Because retinopathy was part of the inclusion criteria of FIDELIO-DKD, it can be assumed that its investigation was mandated by the study protocol at or prior to baseline, resulting in more patients being diagnosed and less patients overlooked. Furthermore, it appears that retinopathy is less well investigated and documented in clinical practice, especially in its early stages [ 36 ]. (2) On the contrary, diabetic neuropathy was more often diagnosed in the registry population than in the RCT patients.…”

Atatürk Üniversitesi Eğitim Aile Sağlığı Merkezlerine Kayıtlı Hastalarda Diyabetik Retinopati Sıklığı, İlişkili Faktörler ve Diyabetik Retinopati Farkındalığı: Kesitsel Bir Çalışma

“…DM hastalarında sistolik kan basıncının 10 mmHg artışının DRP için bir risk faktörü olduğu belirtilmiştir. 23 Çalışmamızda da DRP'si mevcut olan hastalarda olmayanlara göre sistolik kan basıncı anlamlı derecede yüksekti.…”

Diabetic retinopathy in diabetic patients versus diabetic with co-morbid hypertensive patients.

“…16 Li YT, Wang Y, Hu XJ, have found in their study that DR was more pronounced in diabetic patients associated with uncontrolled hypertension as compared to controlled hypertension giving correlation test p <0.001. 17 Lee JH, Kim YA, Lee Y have reported vascular complication in the form of DR in interarm blood pressure difference in 28.77% patients. 18 Atchison E, Barkmeire A have noted found in their study increased severity of DR in patients associated with hypertension and the progression is decelerated if hypertension is well controlled.…”