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)
Highlights
It is projected that over one in ten (10.4%) adults aged 20–79 years will be living with a diagnosis of diabetes in 2040 [1]
This was a cross-sectional analysis of the baseline data from a cohort of adult Chinese patients diagnosed with type 2 diabetes mellitus (T2DM) attending ophthalmoscopic exams, who were referred from primary care facilities through a specialist–generalist working alliance consisting of 18 community health centres (CHCs) in Guangzhou, southern China
Similar to previous studies in the UK [22] and multi-ethnic Asian population [23], we found that BMI levels were inversely associated with diabetic retinopathy (DR), and that increased physical activity was associated with less severe levels of DR, independent of the effects of haemoglobin A1c (HbA1c) and BMI
Summary
It is projected that over one in ten (10.4%) adults aged 20–79 years will be living with a diagnosis of diabetes in 2040 [1]. As the most common form of diabetes that shares concomitant risk factors with hypertension, type 2 diabetes mellitus (T2DM) poses enormous threats to health care with increased risks of both adverse cardiovascular and microvascular events [2]. As the leading cause of diabetes-related visual impairment and blindness, a worsening of DR is a major fear of most diabetic patients who may suffer increased distress and live with reduced function in daily life [5]. Global evidence suggests that longer duration of diabetes, suboptimal level of glycaemic control, and hypertension are strongly related to the onset and progression of DR [8,9,10,11]. Beneficial effects have been demonstrated in blood glucose control to prevent DR among patients with T2DM, while simultaneous blood pressure (BP) control is of equal importance [12,13,14]
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