Why Do Optometrists Measure Blood Pressure Of Their Patients

Photo Credit: teamforhealthylife.com

The arguments favoring optometrists' measuring their patients' blood pressures were reviewed in Optometry Reconsidered Optom. Monthly, 1977. Many people, who would not regularly visit a physician, will visit an optometrist routinely for vision care.

A high percentage of patients who visit optometrists have headache as a primary or a secondary complaint. The detection of hypertension at an early stage may not only prolong the patient's life, but also prevent the occurrence of hypertensive retinopathy and other ocular effects of hypertension.

The need to incorporate blood pressure measurement in optometry clinics cannot be overemphasized. Apart from being the only health care that may be available to some individuals, the knowledge of the blood pressure status of a patient helps in proper diagnosis and management of some ocular diseases and proper referrals.

Essential hypertension, that is, hypertension of unknown cause, accounts for over 90% of all cases of high blood pressure. Patients with essential hypertension are usually asymptomatic, but have an increased risk of stroke, heart attack and premature death. The target organs are usually the eyes, heart, brain and kidneys. Risk factors include heredity, cigarette smoking, high cholesterol level, obesity, excessive caffeine consumption, stress and alcohol ingestion.

About 46.1% individuals suffering from hypertension are unaware that they have the disease and of the patients who know they are hypertensive, 43% has inadequate control of their blood pressure. Thus, it is good news to know that you are hypertensive.

An evaluation of the status of the retinal vessels is an important part of the optometrist's ocular health assessment routine. Since hypertension is a generalized condition, the presence of hypertensive changes in the vessels of the retina indicates that similar changes may be taking place in the blood vessels of the brain, the heart, the aorta and the kidneys.

Photo Credit: homeremedyhacks.com

Early indications of hypertensive retinopathy (retinal damage caused by hypertension) include a reduction in the caliber of the retinal arterioles and the presence of localized irregularities and focal contractions; while the later, more severe, changes include flame-shaped hemorrhage, cotton wool exudates, papilledema and lipid deposits in the form of star figure at the macula. Once hypertensive changes occur in the retinal vessels, these changes are sooner or later accompanied by the retinopathy of arteriolar sclerosis, which is characterized by the familiar arteriovenous crossing changes and by changes in the appearance of the arterial walls.

It has become obvious that hypertension can be detected at a much earlier stages by measuring the patient's blood pressure than by waiting for the appearance of arterial narrowing and other ophthalmoscopic signs. There would be little advantage in the early detection of hypertension unless effective forms of treatment were available. Although antihypertension therapy is the main form of treatment available, patients’ education is also an important aspect of the treatment.

                                        

The etiology of hypertension, like that of anomalies of refraction and binocular vision, involves both hereditary and environmental components. This being the case, optometrists as primary health care practitioners, have an obligation to inform their patients of the preventative measures that are available to them. These preventative measures may be based on the risk factors (as described earlier). Although nothing can be done about a patient's sex, race or inheritance and perhaps little may be done in regard to social or economic status, the risk factors over which the patient can exert some degree of control are salt intake, weight, smoking and stress.

Patients should be made aware that even a small elevation of pressure as compared to the 140/90mmHg upper end of the normal range is associated with increased risk of cardiovascular cerebral or renal disease; and that even within the normal blood pressure range, there is a positive relationship between arterial pressure and mortality.

It is undoubtedly true that large proportion of the population visit a medical practitioner only rarely. This is particularly true of males, who are more at risk in regard to hypertension but are less apt to visit medical practitioners than are women. Many of these same people however visit an eye practitioner on a regular basis. The optometrist therefore can play a valuable role in the community by screening for hypertension and this role is all more important since hypertension can result in significant visual morbidity.