Concerted hypertension management can significantly reduce patients' risk of cardiovascular events, effectively saving lives and underscoring its necessary inclusion in optometric examinations.
Published in the New England Journal of Medicine in November 2015, the Systolic Blood Pressure Intervention Trial (SPRINT) determined intensive high blood (BP) pressure management below the commonly accepted BP targets outlined by the National Heart, Lung and Blood Institute guideline panels—known as Joint National Committees (JNC) 7 and 8—could significantly lower rates of fatal and nonfatal cardiovascular events.
High BP, typically characterized as systolic BP above 140 mm Hg and diastolic BP above 90 mm Hg, affects nearly 90 million U.S. adults, the American Heart Association (AHA) estimates. In the past decade, JNC 7 and 8 encouraged drug intervention to lower systolic BP less than 150 mm Hg and diastolic BP less than 90 mm Hg. But the SPRINT study found success with even more aggressive targets.
This study determined lower systolic BP targets of less than 120 mm Hg—compared to a 140 mm Hg target—resulted in a 25% lower relative risk of primary outcome, including lower rates of heart failure (38% lower relative risk), death from cardiovascular causes (43% lower relative risk), and any cause death (27% lower relative risk).
These positive outcomes continue to resonate in health care. Most recently, Loyola University Chicago researcher and nephrologist Holly Mattix-Kramer, M.D., concluded this management course could save more than 100,000 Americans yearly, two-thirds men and two-thirds 75 or older. Her conclusions were presented this past September at the AHA's Council on Hypertension 2016 Scientific Sessions.
"When the treatment goal was lowered to a maximum of 120 mm Hg, there was a huge reduction in mortality," Dr. Mattix-Kramer said in a news release. "Few other medical interventions have such a large effect."
Hypertension and optometry
Although more than 1 in 3 U.S. adults have hypertension, almost half do not control their blood pressure, and another 13 million aren't even aware they have this asymptomatic condition. Despite millions of hypertensives presenting in clinical settings, many remain undiagnosed— essentially "hiding in plain sight," the Centers for Disease Control and Prevention says.
Given that some patients often visit their doctor of optometry more frequently than their primary care provider, screening and monitoring hypertension in the optometric setting is an effective and beneficial practice. Already many doctors of optometry use sphygmomanometers as part of a regular, dilated comprehensive eye examination to provide a complete picture of the patient's health. And the health industry is taking notice.
UnitedHealthcare (UHC) published a 2014 study that shows "eye exams can facilitate identification and intervention of various high-cost chronic diseases," as well as "facilitate the management of diagnosed medical conditions." Among those conditions most commonly identified by eye care providers, hypertension, diabetes and high cholesterol. "Optometry is vitally important in screening patients for hypertension and for diagnosing hypertensive retinopathy," writes Leonard Steiner, O.D., AOA Health Promotions Committee (HPC) member.
Helpful resources for doctors, paraoptometrics
To help optometric practices—doctors and paraoptometrics—establish such routine BP screenings, AOA's HPC put together a hypertension white paper. This reference resource offers the 'what, who and why' of hypertension to help monitor and educate patients on the importance of BP control. The resource offers the commonly accepted systolic and diastolic BP ranges, a primer on the SPRINT study and talking points that could help keep patients' BP in check.
"Discussing and explaining to your patients the need to control their blood pressure will prevent the devastating complications that occur from hypertension, and the new results from the SPRINT study for intensive blood pressure control will save lives," Dr. Steiner writes.
The American Diabetes Association® (ADA) reported, in time for National Diabetes Month in November, that total annual costs of diabetes in 2022 was $412.9 billion, most of it in direct medical costs. How can doctors of optometry help in the fight to lower the prevalence of diabetes?
Doctors of optometry should consider the benefits of adding office-based laser procedures, such as YAG capsulotomy (after cataract surgery) or selective laser trabeculoplasty (SLT, for glaucoma), to their practice.
Doctors of optometry are performing office-based laser procedures in 11 states, as AOA affiliates have seen historic scope expansion wins in the past four years and momentum continues to build. Doctors of optometry are pursuing legislation in other states that would allow them to serve their patients at the highest level of their education and training. Some of these optometrists, who have performed hundreds of laser procedures, share key considerations in providing this care to patients.