Heart to heart: New blood pressure guideline can spark conversation between doctors of optometry and patients

A new high blood pressure guideline may provide an opportunity for doctors of optometry to have a heart-to-heart conversation with their patients about hypertension and its impact on their eyes and vision.

Untreated, hypertension is a risk factor for diabetic retinopathy, optic neuropathy, choroidopathy, glaucoma and macular degeneration. Beyond these eye conditions, there are several systemic diseases associated with hypertension: heart disease, stroke, dementia and kidney failure, to name a few.

The 2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults was released last November and published simultaneously in the Nov. 13 issues of Journal of the American College of Cardiology and Hypertension. The guideline is the consensus of 21 scientific and health experts from the American College of Cardiology, the American Heart Association and nine other health care groups.

• The new hypertension guideline includes the following updates:
• Normal blood pressure: Less than 120/80 mm Hg
• Elevated blood pressure: Systolic (top number) between 120-129 and diastolic (bottom number) less than 80
• Stage 1: Systolic between 130-139 or diastolic between 80-89
• Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg
• Hypertensive crisis: Systolic over 180 and/or diastolic over 120. Patients are advised to immediately contact their doctors.

Beyond the change in definition for high blood pressure from 140/90, the new guideline eliminates the "prehypertension" category for the elevated and Stage 1 and discusses treatments (medications and lifestyle modification including exercise and a healthy diet).

The Centers for Disease Control and Prevention has estimated that 1 in 3 American adults has high blood pressure—costing this country about $46 billion a year in health care services, medications and missed work days. However, the new guideline means that nearly half of adults (46%) are at risk for hypertension. But few will require an adjustment in their medication. Says the guideline's lead author, Tulane University physician-scientist, Paul Whelton: "It doesn't mean you need medication, but it's a yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches."

Role of doctors of optometry

In 2016, the AOA Health Promotions Committee (HPC) issued a one-sheet paper, The 3 W's—What, Who and Why on hypertension for doctors of optometry and paraoptometric staff who check their patients' blood pressure along with their other vitals. 

The new guideline offers doctors of optometry an opportunity to discuss high blood pressure during office visits with patients. Especially because the earlier hypertension can be detected and treated the better.

"I think awareness is the key," says Daniel Bintz, O.D., who practices in Oklahoma and is a member of the HPC, noting that some patients may be "frustrated" by the moving targets or the potential for an increase in pharmaceutical costs.
"Blood pressure should be taken and discussed at every visit to the office of a doctor of optometry. If undiagnosed hypertension is detected, the patient should, at the least, be given a business card with BP and time taken to give to his or her primary care physician. If hypertension is in the 'danger zone,' they should be set up with their primary care physician before leaving the office of their doctor of optometry, if possible."

Learn more about educating patients about hypertension on page 30 of the September 2017 edition of AOA Focus.